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HomeMy WebLinkAboutC&D Form_J&A Home Improvements.pdf1.�� City of Diamond Bar .' DIAMOND BAR L, AR 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(a)dian1oudbarca.LFov Complete before obtaining a building, combination or demolition permit Submit this form and your deposit to the Building and Safety Drvisian I°cated st! 21810 Copley Dr. Diamond Bar, CA. 91765 Applicant Contact Information: Name_ CG fr, Title ]FLz A,,_Company Address ' City { a e State {A— Zip US S 5 Phone Email c] Project I�ormafioll:- + : ■ Permit No. fM aAt. -- I "a U VaBev Vista ❑ WM [Self Haul Project Address rn A Zip Project Type: ❑ New Construction ©`AdditionlAIteration ❑ Demolition Building Type: ❑ Commercial ff—Residential TO BE FILLED OUT BY CITY STAFF Estimated Square Feet _ �- ?2 "C&D Deposit" Paid $ 2 So . Cr' Estimated Start Date 9 Staff Initials Q Date Paid / 1 !. R-19r Estimated Completion Date Fill out the table with estimated quantities in tons for each material that will be generated by your project. Nate: A + B = C Material Type A E B Estimated Salvage,: Estimated Reuse or Recycle ; Disposal Trash Y P (Trash) C Estimated Total Debris Quantity Q ty Applicant Self Haul (check} Certified Recycling or Facility in Disposal Destination Asphalt & Concrete 0.00 Brick 1 Masonry 1 Tile 0.00 Cabinets, Doors, Fixtures, Windows (circle all that apply) Q DQ ❑ Cardboard 0.00 Carpet, Padding 1 Foam 0.00 Ceiling Tile (acousdc) 0.00 Dirt 0.00 Drywall Q,QQ Landscape Debris 0,00 LJ Mixed C&D Debris Q.QQ Mixed Inerts Q, 40 Roofing Materials Q,QQ Scrap Metal Q,QQ Stucco 0.00 Unpainted Wood & Pallets 0.00 Garbage 1 Trash 0.00 Other: 0.00 TOTAL O.QQ 2 0.00on 5 0.00 1 Qo% To estimate Recycling Rate: (Total A/Total C) x 100 = ling °/° 0.00% Applicant Name: i Signature: Date; q- For information on construction and demolition waste managem ans contact the City of Diamond Bar Environmental Services at 909.839.7015 or via email to areendb(&diamondbarca.irov - 1 - 09/28/17