HomeMy WebLinkAboutC&D Form_John Almenderez Roofing.pdfff_ City of Diamond Bar
DIAM6ND BAR
Construction & Demolition (C&D) Debris Plan
Required For all covered projects, 1,000 sq. ft or more. The deposit shall be returned, to the applicant, without
interest, in total or proportion upon submittal of proof that no less than 75% of the C&D was diverted.
Use of unauthorized waste haulers may also result in forfeit of the deposits.
Receipts and weight tickets can be submitted to: greendb@diamondbarea.gov
■ posit (per project):1 11 for each estimated ton,no l and not- $ ill
Complete before obtaining a building, combination or demolition permit.
Submit this form and your deposit to the Building and Safety Divisiou Iota ted at: 2I810 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information:
Name "),3V 6j �� ty- d 1 `] . ' L Title ° Company
Address ��� Ct\ 1'Y . n C 1 City �1�O \,V% State Zip AS'L-` ,
PhonSL6Email
Project Information: Indicate Waste Haulerfor
PermitNlo. ► >W ak•4— ❑ Valley Vista ❑ WM ® Self Haul
Project Address \ . r V� �'. fit, � t as Zip
Project Type: ❑ New Construction ❑ Addition1.41teration -b Demolition
Building Type: ❑ Commercial ❑ Residential
Estimated Square Feet. UC; TO BE FILLED OUT BY CITY STAFF
Estimated Start Date --kk
41 / 1 1 "C&D Deposit" Paid $ 2 'S c+ • Qr—
Estimated Completion Date '1CJ�'A
Staff Initials 0 -N Date Paid mil -a,/ 2 4
�1 1� /
Fill out the table with esfrmrated gaantities in tons for each material that will be generated by your project Note: A + B = C
A B C Applicant Self Certified Recycling
Material Type Estimated Salvage„ Estimated Estimated Total Haul (check) Facility or
Reuse or Recycle ; Disposal (Trash) Debris Quantity Disposal Destination
Asphalt & Concrete 0.00
Brick / Masonry / Tile 00
Cabinets, Doors, Fixtures, �� ❑
Windows (circle ail that ap iy)
Cardboard 0,00
Carpet, Padding / Foam 0.00
Ceiling Tile (acoustic) 00
Dirt 0.00
Drywall 0.00
Landscape Debris 00 Li
Mixed C&D Debris 00
Mixed lnertsfl
Roof ag Materials d
Scrap Metal 4.00 1i `
Stucco 40
Unpainted Wood & Pallets 0.00
Garbage / Trash 0.00
Other: 0.00
TOTAL 0.00 .0.00 0.00
To estimate Recycling Rate: (Total A/Total Q x 100 =,Recycling % 0.00%
Applicant Name: f���, t �i,"mow �, Signature: Date:
For information on construction and demolition waste management plans contact the City of Diamond Bar
Environmental Services at 909.839.7015 or via email to greendb@diamondbarca.gov
- 1 - 09/28/17