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Home My WebLink About1040 CARLSBAD VILLAGE DR; 102; CBC2025-0025; Recycle, -~1--City of Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN B-59 Development Services Building Division 1635 Faraday Avenue www.carlsbadca.gov This form shall be completed for all demolitions and new construction, additions, and alterations. The California's Green Building Standards Code (CALGreen) requires that at least 65% of construction site debris generated during demolition projects, most new construction, as well as the majority of building additions or alterations be recycled, reused, or otherwise diverted from landfill disposal. STEP 1: The Applicant must submit PART 1 of this form before a building permit application is approved. STEP 2: The permit holder shall utilize a waste management company that can provide verifiable documentation that meets 65% waste diversion. Republic Services is the exclusive franchised waste hauler in the City of Carlsbad. • Option A-Roll-Off Bins: Call Customer Service (760) 332-6464 and ask for a C&D account for waste diversion. Republic Services will provide roll-off bins for construction waste. • Option B -Self Haul to Republic Services or other dump site that can provide verifiable documentation. It must be a Certified Source Separated Recycling Facility. When you enter the site, explain to gate operator that this is C&D material. When you exit the site, request a receipt and certificate from gate operator for waste diversion. STEP 3: Prior to permit close-out (permit final), the permit holder shall complete PART 2 of this form and submit all trash and recycling weight receipts to the building inspector. Waste log, acknowledgement, and tickets must be submitted to release your certificate of occupancy. APPLICANT CERTIFICATIONS: CHECK EACH BOX 0 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. 0 I understand the waste diversion requirements of the State of California and submit this Construction Waste Management Plan pursuant to California Green Building Standards Code 4.408.2 or 5.408.1.1. Failure to provide documentation of C&D reporting, reporting of waste diversion less than 65%, and failure to provide adequate weight receipts, may result in enforcement action against me or other responsible parties, including a notice of violation, citations, and any other remedies provided in Chapters 1.08 and 1.10 of the Carlsbad Municipal Code. Projects are required to submit their Waste Log, Acknowledgement Form, and Weight Receipts prior to Certificate of Occupancy (CO) issuance. 0 This project does not involve disposal of universal or hazardous waste OR this project includes disposal of universal or hazardous waste in a responsible, safe and verifiable manner. Disposal of asbestos- containing materials, batteries, electronic waste, fluorescent bulbs, lead based paints, mercury containing equipment and refrigerants, require special processing prior to commencement of construction or demolition activities. Digitally signed by Sonny Talamantes Sonny Talamantes DN:cn=SoonyTala_mantes,o=Da,ns&AdamsConstrucUon,lnc,ou, emai1=sonnyt@dav1sadams.com, c=US Date: 2025.04.08 15:59:28-07'00' Signature of Applicant Page 1 of 4 Date: 04082025 rev 4/24 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. ____________ Project Title Perlman Clinic Project Address 1040 Carlsbad Village Dr, Suite 102, Carlsbad CA 92008 APN 203-320-49 Applicant Name Talamantes, Sonny Phone 858-268-9831 Last First SECTION B Complete the following table with estimated waste tonnage to be generated by your project. A B C Material Type Estimated Place a ( ✓) check Place a ( ✓) check next Place a ( ✓) check next Waste Quantity next to items to be to 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 0.18 □ □ ~ 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) 4.5 □ □ ~ Landscape Debris (brush, trees, □ □ □ stumps, etc.) No dirt. Unpainted Wood & Pallets □ □ □ Roofing Materials □ □ □ Scrap Metal □ □ □ Stucco □ □ □ Other: □ □ □ TOTAL 28.44 SECTION C To meet 65% Diversion Requirement (estimate) x 0.65 = 3-276 tons -------------------5.04 Total Estimated Waste from above Minimum Required Diversion Applic~t Signature Sonny Talamantes 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 Permit No. ____________ Project Title Project Address __________________________ APN Applicant Name _______________________ Phone 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 Diversion Rate Achieved Actual Amt Reused or Salvaged 0 Actual Amt Recycled 5tons 0 Actual Amt Disposed in Landfill 0 Destination Facility (Name, Address, Phone) Palomar Transfer Station, 5960 El Camino Real -(760) 603-0153 = % ~65% --------~---------------- Total of columns A + B Total of columns A+ B + C DIVERSION Attach the following documentation to this Report: Return completed form and documentation to: • Original recycling weight tickets, landfill weight tickets 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 _____________ _ Page 3 of 4 rev 4/24 CONVERSION TABLE FOR COMMON CONTRUCTION WASTE. This document is informational only and may be used to convert truckload quantities to tons. Column A Column B Column C Category Material Volume TonsLUnit Tons Mixed Debris Construction 1 cy X 0.18 = 0.18 Demolition cy X 1.19 = Asphalt/Concrete Asphalt (broken) cy X 0.70 = Concrete (broken) cy X 1.20 = Concrete (solid slab) cy X 1.30 = Brick/Masonry/Tile Brick (broken) cy X 0.70 = Brick (whole, palletized) cy X 1.51 = Masonry brick (broken) cy X 0.60 = Tile sq ft Building Materials (cabinets, doors, windows, etc.) X 0.00175 = cy Cardboard (flat) cy X 0.15 = Carpet By square foot sq ft X 0.05 = By cubic yard cy X 0.0005 = Carpet Padding/Foam sq ft X 0.30 = Ceiling Tiles Whole (palletized) cy X 0.000125 = Loose cy X 0.0003 = Drywall (new or used) 1/2" (by square foot) sq ft 5/8" (by square foot) 50 X 0.09 = 4.5 sq ft Demo/used (by cu. yd.) cy X 0.0008 = Landscape Debris (brush, trees, etc.) cy X 0.00105 = Asphalt Composition X 0.25 Shingles, asphalt Shingle = cy Unpainted Wood/Pallets By board foot X 0.15 = bd ft By cubic yard cy X 0.22 = Trash/Garbage cy X 0.001375 = Other (estimated weight) cy X 0.15 = cy cy X 0.18 = cy X estimate = Total ALL = 4.68 Page 4 of 4 rev 4/24 . {cityof Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN B-_59 . Development Services :. Building Divi~ion 1635 Faraday Avenue www.carJsbadca.gov This form shall be completed for all demolitions and new construction, additions, and alterations. The California's Green Building Standards Code (CALGreen) requires that at least 65% of construction site debris generated during demolition projects, most new construction, as well as the majority of building additions or alterations be recycled, reused, or otherwise diverted from landfill disposal. STEP 1: The Applicant must submit PART 1 of this form before a building permit application is approved, STEP 2: The permit holder shall utilize a wa ste management company that can provide verifiable documentation that meets 65% waste diversion, Republic Services is the exclusive franchised waste hauler in the City of Carlsbad . • Option A -Roll-Off Bins: Call Customer Service (760) 332-6464 and ask for a C&D account for waste diversion. Republic Services will provide roll-off bins for construction waste. • Option B -Self Haul to Republic Services or other dump site that can provide verifiable documentation. It must be a Certified Source Separated Recycling Facility. When you enter the site, explain to gate operator that this is C&D material. When you exit the site, request a receipt and certificate from gate operator for waste diversion, STEP 3: Prior to permit close-out (permit final), the permit holder shall complete PART 2 of this form and submit all trash and recycling weight receipts to the building inspector. Waste log, acknowledgement, and tickets must be submitted to release your certificate of occupancy. APPLICANT CERTIFICATIONS: CHECK EACH BOX ~ 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. I understand the waste diversion requirements of the State of California and submit this Construction Waste Management Plan pursuant to California Green Building Standards Code 4.408.2 or 5.408.1.1. Failure to provide documentation of C&D reporting, reporting of waste diversion less than 65%, and failure to provide adequate weight receipts, may result in enforcement action against me or other responsible parties, including a notice of violation, citations, and any other remedies provided in Chapters 1.08 and 1.10 of the Carlsbad Municipal Code . Projects are required to submit their Waste Log, Acknowledgement Form, and Weight Receipts prior to Certificate of Occupancy (CO) issuance. This project does not involve disposal of universal or hazardous waste OR this project includes disposal of universal or hazardous waste in a responsible, safe and verifiable manner. Disposal of asbestos- containing materials, batteries, electronic waste, fluorescent bulbs, lead based paints, mercury containing equipment and refrigerants, require special processing prior to commencement of c str n or demolition activities. Page 1 of 4 rev 4/24 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. ____________ Project Title Project Address _________________________ ---'APN Applicant Name _____________________ Phone Last First SECTION B Complete the following t,;1ble with estimated waste tonnage to be generated by your project, A B C Material Type Estimated Place a (✓) check Place a (✓) check next Place a (✓) check next Waste Quantity next to items to be to 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 0 0 □ ro/1-aff bins. Mixed C&D Debris Asphalt & Concrete 1 ton □ □ □ 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 23 SECTION C To meet 65% Diversion Requirement (estimate) x 0.65 = 1 ton tons -------------------0.0 Total Estimated Waste from above Minimum Required Diversion ApplicRt Signature ____________________ Date _____________ _ 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 Permit No. CBC2025-0025 Project Title Perlman Clini Carlsbad Village Project Address 1040 Carlsbad Village Drive #102 Carlsbad, CA 92008 Applicant Name Davis & Adams Construction, Inc. Last First APN 203-320-49 Phone 858-254-8486 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 page~ are available if necessary. Use City Conversion Table·to convert volume to tons. A B C Date Example: 01/01/2020 05/19/25 Material Type Concrete (broken) Concrete , ®TOTAL Actual Amt Reused or Salvaged 1 7 Actual Amt Actual Amt Destination Facility Recycled Disposed in (Name, Address, Phone) Landfill Palomar Transfer Station, 5960 El 5 tons Camino Real -{760} 603-0153 1 0 Moodys -Oceanside 6 0 Diversion Rate Achieved _6 _______ ~_6 __________ =_1_0_0 ___ % ~ 65% Total of columns A+ B Total of columns A + B + C DIVERSION 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 SECTION D Return completed form and documentation to: City of Carlsbad Building Division (1st Floor) 1635 Faraday Avenue Carlsbad, CA 92008 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 -~l=-.:.:..:..Jo.....L.:..v::.,;~~.L5-~:___~:....__ ___ Date __ b-"""'------f-)-'-,_q__,__-Jw __ ?;_~----1 Page 3 of 4 rev 4/24 CONVERSION TABLE FOR COMMON CONTRUCT/ON WASTE. This document is informational only and may be used to convert truckload quantities to tons. Column A Column B Column C Category Material Volume TonsLUnit Tons Mixed Debris Construction cy X 0.18 = Demolition cy X 1.19 = Asphalt/Concrete Asphalt (broken) cy X 0.70 = Concrete (broken) 1.0 tons cy X 1.20 = 1.20 Concrete (solid slab) cy X 1.30 = Brick/Masonry/Tile Brick (broken) cy X 0.70 = Brick (whole, palletized) cy X 1.51 = Masonry brick (broken) cy X 0.60 = Tile sq ft Building Materials (cabinets, doors, windows, etc.) X 0.00175 = cy Cardboard (flat) cy X 0.15 = Carpet By square foot sq ft X 0.05 = By cubic yard cy X 0.0005 = Carpet Padding/Foam sq ft X 0.30 = Ceiling Tiles Whole (palletized) cy X 0.000125 = Loose cy X 0.0003 = Drywall (new or used) 1/2" (by square foot) sq ft 5/8" (by square foot) X 0.09 = sq ft Demo/used (by cu. yd.) cy X 0.0008 = Landscape Debris (brush, trees, etc.) cy X 0.00105 = Asphalt Composition X 0.25 Shingles, asphalt Shingle = cy Unpainted Wood/Pallets By board foot X 0.15 = bd ft By cubic yard cy X 0.22 = Trash/Garbage cy X 0.001375 = Other (estimated weight) cy X cy 0.15 = cy X 0.18 = cy X estimate = Total ALL = 1.2 Page 4 of 4 rev 4/24 ,._.--~~OLITION DIVERSION CERTIFICATE RECEIVED AT: MOODY'S· EL CORAZON RECLAMATION PROCESSED AT: 321 O OCEANSIDE BLVD., OCEANSIDE, CA (760) 433-3316 -~. ,, i I --~~-·· .H CHECK NAME CITY OF ORIGIN: JOB LOCATION I l JOB# CHARGE COMMERCIAL ( DATE ,...,,.-1 (' ( ' ,,/ RESIDENCE -flME>' ,, / ; ', ,, / TONS DIVERSION .I L. 100'% PU TRAILER FLATBED BOBTAIL 10•WHEEL END DUMP T&T ) / \ v' ~ ,..,, MATERIAL / / _; ... ,,. ,. ., ,,) I LOAD COUNT ,_/{ i / •' ·~·-· 1 2 3 4 5·· 6 7 8 9 10 , _IL)i:::D -L -L~w '• .,/ if f~.,.,.r I l-~' ~ E l ~ uJ L _;: J ...._,, # LOADS X PRICE OTHER CHARGES cJvblN/ $ TOTAL DUE I ' i SIGNATURE This certifies that the company above has utilized a recycling facility to divert construction demolition materials in accordance with LEED requirements. The diversion Is based on an overall tonnage percentage of the respective facility. TRUCK# MOODY'S Is not responsible for damage to vehicle while being loacled or unloaded in yarcl. JOBCOflY 109 Scanned with m, CamScanner·