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Home My WebLink About1800 GUEVARA RD; ; CBR2023-1870; Recycle\_._ City of Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN 8-59 Develor Building Division 1635 Faraday Avenue 760-602-2719 www. carlsbadca. gov Many of the materials generated from your project can be recycled. You are required to list materials that will be reused, recycled or disposed from your project. If you have questions about the recycling requirement or completing this form, please contact Waste Management at (760) 929-9400, a certified C&D recycler, or the Carlsbad Building Division at (760) 602-2700. Please note: Unless you are self-hauling, Waste Management or approved haulers must be used for all construction projects within the City of Carlsbad. PART 1 Comp te and submit h,; form wh c1 Bwldmg Per-mt. NotP. Pe>rm t w tho ta c.ompl ted Construction w. c:-t '\/lanar."m • 11t Pl Applicant Information Permit No. 00123234 Project Title Dumouchel-Rudden Addition Project Address 1800 Guevara Rd. Applicant Name Dumouchel, Jean-Paul Last First Applicant Address 1800 Guevara Rd APN Phone 760 214-0670 Applicant Mailing Address E-mail Address jpdumouchel@yahoo.com (if different than project address) Project Type (check all that apply): Residential 0 Commercial □ Public Building □ sued Brief Descriptio Addition ----------------------------------- Project Size Lf o 2 Estimated Cost of Project $ __ ~_0__,__o_O_o_-_<>t> ________ _ (square footage) Please check the appropriate box: j ✓ I I plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction. DI plan on self-hauling to a certified recycling facility and will provide all receipts after construction. D This is a proposed LEED certified project and I plan on separating materials on site in conjunction with WASTE MANAGEMENT. Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the information provided in and with this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have reviewed the accuracy of the information, and that the information is true and correct to the best of my knowledge and belief. Go P • t N Jean-Paul Dumouchel \ -'-fl 06/13/.2 3 rm ame. ___________ Signature fw~~ Date Page 1 of 3 Rev. 2.10.21 RT l ComJ)I te, obtain r;1gnaturc dnd ubm t ti'-f ,rm when. pplymg fo cl Bu ldtng Pe mt f\Jote PerMit will {contd) not b 1ssuC'd w,tho1Jt a completed Con t ct1011 W ste Manap;ement Plan DEBRIS RECYCLING ESTIMATE: Permit No. _0_0_1_2_3_2_3_4 _______ Project Title Dumouchel-Rudden Addition 1800 Guevara Rd. Project Address __________________________ APN Applicant Name Dumouchel, Jean-Paul Phone 7(60 )214-0670 Last First SECTION B Complete the following table with estimated waste tonnage to be generated by your project. This is your plan for construction waste management. Changes can be made on the final recycle report. Goal: the diversion rate shall be 65% by weights of debris. Material Type Complete this line of the table only if only using WASTE MANAGEMENT roll-off bins. Mixed C&D Debris Asphalt & Concrete Brick/ Masonry/ Tile Mixed Inert Debris Cabinets, Doors, Fixtures, Windows (circle all that apply) Carpet Carpet Padding/ Foam Cardboard Ceiling Tile (acoustic) Drywall (used, new, scrap) Landscape Debris (brush, trees, stumps, etc.) No dirt. Unpainted Wood & Pallets Roofing Materials Scrap Metal Stucco Other: TOTAL SECTION C A Estimated Place a (Q) check Waste Quantity next to items to be (tons) reused or salvaged □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ = . (, B C Place a (Q) check next Place a (Q) check next to items to be to items to be recycled disposed at landfill □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ To meet 65% Diversion Requirement {estimate) _ _.::._/ _. <, ___ x 0.65 = __ ..._/_. _6_'f..__ ___ tons Contractor/Owner Signature [), r o,omrimmed Wo,te /mm alw" ~~t:J,..A-Date Minimum Required Diversion Page 2 of4 Rev. 11112118 PART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final building approval. DEBRIS RECYCLING REPORT (ACTUAL): Acknowledgement I certify under penalty of perjury under the laws of t he State of Ca lifornia that the information provided in and with this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have reviewed the accuracy of the information, and that the information is true and correct to the best of my knowledge and belief. Use this Final Log below to track loads of materials as they leave the job site. 0 □SAVE RECEIPTS□ 0 Ind icate FINAL quantities in );Qns for each material and save receipts and documents from facilities where material is taken. Additional Project Log pages are available if necessary. Use City Conversion Table to convert volume to tons. A B C Date Material Type Actual Amt Actual Amt Actual Amt Destination Facility Reused or Recycled Disposed in (Name, Address, Phone) Salvaged Landfill Example: 01/05/2018 Palomar Transfer Station, 5960 El Concrete (broken) 5 tons Camino Real -(760) 603-0153 07 t..o 23 I>l/2.T /3. S--f-,.5, -sa...;-l::>~ )(C.V\ q 'j lo> ) Un", d WO-Ot> o. t -/oi11s r=-; <'<!. p L~ c....<. 2-~ ":. 4"'-C:. I t:t,,_,J..f:!'ll bh,., Diversion Rate Achieved Tat Tata/ of columns A + B + C DIVERSION Contractor/Owner Signature ~ ~ Date ~1 I (p / 2o 7..-l/ Attach the following documentation to this Report: • Original recycling weight tickets, landfill weight tickets • Original donation receipts with photos and/or itemized descriptions • Any other relevant information to support Recycling Report Return completed form and documentation to: City of Carlsbad Building Division (1st Floor) 1635 Faraday Avenue Carlsbad, CA 92008 Rev. 51612022 Bart Dixon's boboGI Services Inc NAME ADDRESS CITY PHONE 936 Sunset Dr. Vista Ca. 92081 Office 760-726-3262 fax 760-630-3568 . - Mobile 760-212-8527 DESCRIPTION OF WORK MISCELLANEOUS CHARGES HOURS RATE AMOUNT -- INVOICE NUMBER DATE ORDERED TOTAL LABOR f DCLJ, TOT AL MATERIAL HX), _, DATE STARTED DATE FINISHED TOTAL MISC. SUBTOTAL CUST. SIGNATURE AUTH. SIGNATURE TAX <be2 GRAND TOTAL -_Jf-f LL,)~ ,