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Home My WebLink About1935 CALLE BARCELONA; 175; CBC2023-0032; Recycle•, (city of Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN 8-59 Development Services ,P...-0 Building Division 1635 Faraday Avenue 442-339-2719 www.carlsbadca.gov !J .,\ APPLICABLE TO NEW CONSTRUCTION, ALL RESIDENTIA \».bDITIQ.l\lS •AND ALTERATIONS AND LD·' COMMERCIAL ADDITIONS A ND ALTERATIONS OVER $200K.\;:-J you have questions about the recycling requirement or completing this form, please contact Republic Services at (760) 332-6464 a certified C&D recycler, or the Carlsbad Building Division at (442) 339-2700. Please note: Unless you are self-hauling, Republic Services or approved haulers must be used for all construction projects within the City of Carlsbad. PART 1 Complete and submit this form when applying for a Building Permit. Note: Permits will not be issued without a completed Construction Waste Management Plan. Applicant Information Permit No. C.6t:. 2-023 -00~ 2--ProjectTitle _N~6~C-o..c...=..al.1~~~t,=---1~r_, _\_c_,c._~c~ .......... 4-.'YY'~--- Project Address~l~1-3~<'.?~W.~l~\e~b,,t~r◄_ctl~6\A~fl'-+-t _~___,.4~i±..__-<7 __ 1 J__._5...,._ __ APN 1.J?'i-V\12,.,. D Zf' Applicant Name -oc-kri--Y~V'.\.....,_ _____ Sf~~:e1~N~h'?~~-· ----□ err l~r □ Last First Applicant Address _':t]-.L-t-'-;_j_....._µ__,;~~-C._rl,.____5f----'-','---$"'--"'u"-"-l_._±-t_,__--"Z-_o_'2-________ )-_ ~ietJtM Q ~oki)ll de410~. vo\101 Phone Applicant Mailing Address (if different than project address) Project Type (check all that apply}: Brief Description Residential □ {vv-- - Co~ Public Building □ 0 Ice Project Size __ '--IL J'""'0"-"-(5_O_---'S'--lf=,------Estimated Cost of Project $_1+-~I ?Q~-+J-6_(}.'J ____________ _ (square footage) Please check the appropriate box: I plan on using REPUBLIC SERVICES roll-off bin(s) for all materials and will provide all receipts after construction. I plan on using a City Approved Hauler and will provide all receipts after construction. This is a proposed LEED certified project and I plan on separating materials on site in conjunction with Republic 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. Print Name ___ ~_f~~---~h __ ~_Vl ___ Signature __ ~-"""-.;:....;:..;_:_ __ @=-+-__,~'----Date J Page 1 of 3 Rev. 05122 PART 1 (cont'd) Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will not be issued without a completed Construction Waste Management Plan. DEBRIS RECYCLING ESTIMATE: -ei.,•• Pe rmit No. Project Title Project Address APN Applicant Name Phone ( ) Last First _, ,-i■rei.,■: Complete the following table with estimated waste tonnage to be generated by your project. This is your plan for construction waste m anagement. Changes can be made on the final recycle report. Goal: the diversion rate shall be 65% by weights of debris. A B C M aterial Type Estimated Place a (0) check Place a (0) check next Place a (0) check next Waste Quantity next to items to be t o items to be to items to be (tons) reused or salvaged recycled disposed at landfill 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 □ □ □ Carpe~ Padding/ Foam □ n n . Cardboard □ □ □ Ceiling Tile (acoustic) □ □ □ Drywall (used, new, scrap) □ n □ Landscape Debris (brush, trees, □ stumps, etc.) No dirt. □ □ Unpainted Wood & Pallets □ □ □ Roofing Materials □ □ □ Scrap Metal □ □ □ Stucco □ n n Other: --□ □ □ TOTAL -- -..,:r•ne1 To m eet 65% Diversion Requirement (estimate) X 0.65 = t ons Total Estimated Waste from above Minimum Required Diversion Contractor/Owner Signature Date Page 2 of4 Rev. 05122 PART 1 Complete and submit this form when applying for a building permit. Permits will not be issued •without a completed Construction Waste Management Plan. SECTION A Permit No. l-gL:'.) s:>J.Y-<l<;>~) Project Title Project Address \ 0 (\) L~ l I :c,, f>,..,. < . .-c, J 5.:>-C\ l:t-\ 7 J., APN Applicant Name Lv ·, \ '\'c. ~ M I c., l-z.. l Phone 7 I½ -'6 \6-~ \~ \ Last First SECTION B Complete the following table with estimated waste tonnage to be generated by your project. 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 Estimated Waste Quantity (tons) A B C Place a ( ✓) check next to items to be reused or salvaged Place a{✓) check next to items to be recycled Place a(✓) check next to items to be disposed at landfill SECTION C To meet 65% Diversion Requirement (estimate) 6 x 0.65 = ___ ....;;;5_,_5___._ ______ tons -/47'' E<t;moted Wo,tefrom obwe Applicant Signature---~-....--------------Date _ __;:(:_-..:...~---...,,_~::c~ ... --+-. _____ _ Minimum Required Diversion Page 2 of 4 rev 4/24 PART 2. Complete and submit this form before final inspection. Projects are required to submit their Waste • Log, Acknowledgement Form, and Weight Receipts prior to Certificate of Occupancy {CO) issuance. Failure to provide documentation, reporting of waste diversion less than 65%, and failure to provide adequate weight receipts, may render the Project non-compliant and the responsible parties subject to code enforcement. SECTION A ~~::;;__=:;..;;;,. __ -'6_-~-=..;9~.Project Title Project Address,_-1....°'\-=-~---l.....L..1.--!...~_.::.u..i.t..:L~-l:....ui~c.----------'APN Applicant Name__:w___;,:...:.i,\= ... ------~v'.\---1..J=(.,_L1~\ ___ Phone 'ltt✓i ,~~ s~ \ Last First SECTION B Use this Final Log below to track loads of materials as they leave the job site. @@SAVE RECEIPTS@@ Indicate FINAL quantities in tons 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 Example: 01/01/2020 SECTION C Material Type Concrete (broken) ~TOTAL Actual Amt Reused or Salvaged Diversion Rate Achieved Total of columns A+ B Attach the following documentation to this Report: • Original recycling weight tickets, landfill weight tickets Actual Amt Actual Amt Recycled Disposed in Landfill 5 tons Total of columns A + B + C Destination Facility {Name, Address, Phone) Palomar Transfer Station, 5960 El Camino Real -(760) 603-0153 % <!:65% DIVERSION Return completed form and documentation to: City of Carlsbad • Original donation receipts with photos and/or itemized descriptions Building Division (1st Floor} 1635 Faraday Avenue Carlsbad, CA 92008 • Any other relevant Information to support Recycling Report SECTION D 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. ~, ......._) Applicant Signature_~---+;__---~--~--::::;.._ _______ Date ~-7:-lV\ Page 3 of4 rev 4/24