HomeMy WebLinkAboutC&D Form_LV-M Roofing.pdfff City of Diamond Bar
DlAMQND BAR
L BAR
Construction & Demolition (C&D) Debris Plan
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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.
Receii)ts and weight tickets can be submitted to: greendb(rc diarnondbarca.gov
Complete before obtaining a buflding, combination or demolition permit.
Submit this form and your deposit to the Building and Safety,Division located at: 21810 Copley Dr. Diamond Bar, CA, 91765
Applicant Contact Information:
M
Marne UQ5e /� V'1 +f- hC" 0 1itIe ii.P_ !'+�Iry�C G, y Company LV -- Sp., vie
Address e City3SA h f er h Q, d it o State -C-4 Zip Z y 0
pME f
Phone; •�� C h 9` S Z f g Email Lv M- 0 �J
Project Information: Indicate
permitNo. V-& Q �_ - I a "a ❑ Vallev Vista ❑ vvM Self Haul
Project Address �{ F 01 4 � D • L , Gwh Qh a P A I . 6 A _—, Zip rl i �� 5
Project Type: ❑ New Construction 12 AdditionlAltewtion 3 Demolition
Building Type: Q Commercial fi( Residential
TO BE FILLED OUT BY CITY STAFF
Estimated Square Feet 9C "C&D 4000
Deposit" Paid $
Estimated Start Date �JI _I20Z L4 Staff luitials �� `>r `E Date Paid
Estimated Completion Date 1 1
Fill out the table with estimated quantities in tons for each material that will be generated by your project, dote. A + B C
A R
C
Applicant Self
Certified Recycling
Material Type
Vstimated Salvage,; Estimated
Estimated Total
Haul (check)
Facility or
Reuse or Recycle : Disposal (Trash)
Debris Quantity
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
0.00
Cabinets, Doors, Fixtures,
4.40
Elwindows
(circle all that apply)
Cardboard
0.00
Ll
Carpet, Padding 1 Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
13 all
0.00
Landscape Debris
0.40
Li
Mixed C&D Debris
0,00
Li
Mixed Incas
4.00
Roofing Materials
0.00
Scrap Metal
0.00
Li
Stucco
0.00
Unpainted Wood & Pallets
4.00
Garbage 1 Trash
0.04
Other:
0.00
TOTAL 10.00
:0.00
0.00
To estimate Recycling Rate. (Total AIT atal Q x 100 Recycling % 0,00%
Appficant Name: '.-Sc3 t! rC 11�r: `" - Date: f �-
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
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- 1 - 09/28/17