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HomeMy WebLinkAbout1950 CAMINO VIDA ROBLE; ; CBC2020-0098; Recycle(City of Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN B-59 D~velopment Services 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 ro ects within the City of Carlsbad. PART l 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. CBC2020-0098 Project Title ALPHATEC SPINE Project Address 1950 Camino Vida Roble Applicant Name BVCOR General Contractors, Inc. Last First 0 Contractol' 0 Applicant Address 6490 Marindustry Pl., Suite A, San Diego, CA 92121 Phone E-mail Address cheidmiller@bycor.com _._ _ __,. ________ _ 619 341-1025 Applicant Mailing Address (if different than project address} Project Type (check all that apply}: MSldentlal □ Commerclal 0 Brief Description 7,635 SF Demo of all restrooms Pu~ldlng APN 212-093-1200 Archltecc Other 0 0 -- '"tr Project Slze __ 7_,6_3_s ________ Estlmated Cost of Project $_--'-$_10_6-'-,9_3_3 ___________ _ (square footage} Please check the appropriate box: DI plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction. EJ I 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. Print Name Marianne Lamoureux s•sn•tu~at• 7/22/2020 Page 1 of4 Rev. 711120 PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will (cont'd) not be issued without a completed Construction Waste Management Plan. DEBRIS RECYCLING ESTIMATE: • • Permit No . CBC2020-0098 Project Title Alphatec Spine Project Address 1950 Camino Vida Roble APN 212-093-1200 Applicant Name BYCOR General Contractors, Inc. Phone ( 619 ) 341-1025 Last First • Complete the foUowlng 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" bv wel1hts of debris. 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 recyded disposed at landfill Complete this line of the table only if onl)I U$Hl0 WASTE MANAGEMENT roll-off bins. Mixed a.o Debris Asphalt & Concrete Brick / Masonry/ TIie Mixed Inert Debris Cabinets, Doors, Fixtures, Windows (circle all that apply) Carr1et Carpet Padding/ Foam Cardboard Ceiling TIie (acoustic) Drywall (used, new, scrap) Landscape Debris (brush, trees, stumps, etc.) No dirt. Unpainted Wood & Pallets Roofing Materials Scrao Metal Stucco Other: TOTAL = • To meet 65% Diversion Requirement (estimate) x0.65 = tons Total Estimated Waste from above Minimum Required Diversion Contractor/Owner Signature Date Page 2 of 4 Rev. 711/20 PART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final building approval. DEBRIS RECYCLING REPORT (ACTUAL): I . 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. Permit No. CBC2020-0098 Print Name BYCOR General Contractors, Inc. Address 1950 Camino Vida Roble Date 07/21/2020 .... ,.:,_ 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 8 C Date Materlal Type Actual Amt Actual Amt Actual Amt Destination Faclllty Reused or Recycled Disposed In (Name, Address, Phone) Salva1ed Landfill Exame.le: Palomar Tron5/er Station, 5960 El 01/01/2020 Concrete {broken) Stans Camino Real -17601 603-0153 4/28/20 C&D Material 3.59/88" 4.08 Tons 0.49/ 12" EDCO, 224 S Laa Posaa Rd -(760) 744-2700 4/29/20 C&D Material 2.52 / 68" 3.70 Tons 1.18/32" Escondido Resoun;e RIICOV9!Y, 1044 w Wa&hmntnn Ave -17801 745-3203 5/16/20 Concrete /10096 /09' Moody's, 3210 Oceanaide Blvd. -(760) 433-3316 5/28/20 C&D Material 1.27 /68% 1.87 Tons 0.60/ 3296 All Waye Metal, 1425 N. Magnolia Ave. -(619) 390-6637 6/5/20 8/X Material 0.56/ 1009' 0.56 Tons 0.0/09' Esc.ondldo Raaource Recove,y, 1044 W Waahlnnloo Ave -1760\ 7 45-3203 6/10/20 C&D Material 2.35/68" 3.45 Tons 1.10/32" Sanoo, 8750 Federal BIVd. -(619) 287-7555 6/16/20 Concrete / 1009' /09' Moody'a, 3210 Ooeanalde Blvd. -(780) --◄~ 6/18/20 Concrete / 100% /0% Moody's, 3210 Oceanside Blvd. -(760) 433-3316 7/10/20 Concrete /100% /09' Moody's, 3210 Oceanslde Blvd. • (760) ..... _.,-;,.,. @TOTAL 10.29Tons 13.66 Tons 3.37Tons -.?:65% Diversion Rate Achieved 23.95 I 27.32 = 87.66 % S65%0 Total of columns A+ B Toto/ of columns A + B + C DIVERSION Contractor/Owner Sllftature(/'/'(I/J/rJw~'i,at• 07/21/2020 - Attach the following documentation to this Report:~turn completed form and documentation to: . Original recycling weight tickets, landfill weight tickets City of Car1sbad . Original donation receipts with photos and/or itemized descriptions Building DMsion (1st Floor) • Any other relevant Information to support Recycling Report 1635 Faraday Avenue Car1sbad, CA 92008 Page 3 of4 Rev. 7/1120 EDCO WASTE & RECYCLING SERVICES, INC 224 S . LAS POSAS RD SAN MARCOS, CA 92078 (760) 744-2700 Customer: 1038 DEMKO DRYWALL 419 S MARSHALL AVE EL CAJON, CA 92020 Ticket: 16010 Date: 04/28/20 Commodity Units Rate In: 8: 35 Out: 8:43 4 5 C & D MIX 4 . 0 8 72.00 per TON INVOICE Truck: 0987/0987 Container: Route: 08145 Origin: 081 ALL COUNT 1}:Jx. I/ ...J.J,.... O O < e-Extended ..-.+r ...J J Charge 293.76 [Gross(In): 26,620. lbs Scl#l Tare 18,460 . lbs Scl#l 7 : 8 \ 160. _1b_s_J __ _ TOTAL DUE 2~3.76 '-Construction & Demolition Diversion Certificate •· Diversion Percentage 88% This certifies that the company listed above has utilized an EDCO facility to divert construction demolition terials in accordance with LEED requirement. The diversion tonnage is based on an overall tonnage percentage of the respective EDCO facility. CRUZ DemkO Demol~~n 419 S. Marshall Avenue• El Cejon • California · 92020 · P, 819.590.0026 • F. 919.590.0021 Construction and Demolition Debris Recycling Log Dally Log of Construction and Demolition (C&D) Materials Removed of Reuud on Job Site Name of Person Verifying Accuracy: Kathy Oakley General Contractor. Bycor Project Name: )\lee ProjectAddress: 1950 Camino Vida Roble Carlsbad, CA 92008 Telephone: 619-S/I0.()025 Job#: 0055 The County of San Diego C&D ordinance requlru ,.~Ung of to% inertl & 70% of ,.malning matarlal Ramolnl••Mote<lols Inerts Cabinets, Doors, Wlndowa, Fixtures Mlxod Recyclables Asphalt Cardboard Roofing Matarlals Concrete Carpet Scrap Metal Brick Padding/Foam (carpet) Stucco Masonary Celllng Tllo (accoustlc) Cement (no wire) Tile Drywall (usod) Unpainted Wood & Pallets Dirt Drywall (new, unpainted or scrap) Trash Mixed Inerts Landscaping (brush, tnlff, stumns, etc.) othor (dncribs) other (describe) Dal8 Time Dntlnatlon Location Job# Waight Ticket# Dl'ltir1k>n '% Matartal Type 4/28/20 8:35 EDCO SAN MARCOS 0055 4.08 16010 -C&D MATERIAL 4/29/20 12:23 ESCON RES REC ESCONDIDO 0055 :uo 89341 68% C&D MATERIAL 5/16/ZO 7:'ii7 MOODY'S BONSAll 0055 275069 100% CONCRETE 5/28/20 9:40 ESCON RES REC ESCONDIDO 0055 1.87 6762 68% C&D MATERIAL 6/5/ZO 11:46 All WAYS METALS ELCAION 0055 0.56 434117 100% 8/XWIRE 6/10/20 13:44 SANCO LEMON GROVE 0055 3.45 2530 68% C&D MATERIAL 6/16/20 8:02 MOODY'S BONSALL 0055 277117 100% CONCRETE 6/17/ZO 7:57 MOODY'S BONSAlL 0055 2772U 100% CONCRm 6/19/20 8:00 MOODY'S BONSALL 0055 277389 100% CONCRETE 7/10/20 9:24 MOODY'S BONSALL 0055 278622 100% CONCRETE (1) Mixed bm• mu•t bt lakan to 1n approved mbled pn,ctUlng faclltty (21 MbMt<K, Hlllfflfout O.brl1, TrHtlld Wood, Contarnlnntd Solt and oth•r re.ttlctad matari.l• rt,quln apec,111 handllng. 9020-808 ESCONDIDO RESOURCE ECOVERY AND WAIT• TIIANIFIEft ,eflYICE "We'll Take Care of It" Construction & Demolition Diversion Certificate Received at :Escondido Resource Recovery Date: 6607 Processed At : SRR Lemon Grove, CAD COi San Marcos, CA ~ Customer: -------- Project: Number/De~criptio~" Total Tons Received: 3 7(:rbns Ticket# · n Percentage: ~µo Scale house Operators Signature:-----:ff--,.-Wf..e.<t&.4-!z:1..-- This certifies that the company listed above has utilized a ED with LEED requirements. The diversion tonnage is based o E s,or!d·, do Resource Recovery ;1;?1 W Hission Ave f'~,-1Jnd:do. CA 92025 ("'t') ,'[5-3203 ' .. u'. tompr: 0159 Ticket: 89341 Date: 04/29/20 r>f.MKCJ fJl{YWALL CO, INC ·11 q '> H1-RSHALL AVE fl. CA JUN. CA 92020 l,::,r:,, nod ; t: J Rate INVOICE In: 12:23 Truck: 5397/5397 Out: 12:52 Container· '&xg.) Route: 08614 Origin: 086 Carlsbad /' / Extended 11 Mi XLD C & D IS•n~.,!n): 25.460. Units 3. 70 lbs Scl#5 ~ oos-S-92. 00 per TON ,/ Charge 340.40 lbs] Tare 18. 060. lbs Scl#S Net: 7 (4,00 -~---~R=A~FA-E~LA~----- ,· i \ · ' TOTAL DUE )1. 1 : a :tJ 340 .40 ;;z Escondido Resource Recovery 1021 W Mission Ave Escondido. CA 92025 (760) 745-3203 Customer: 0159 Ticket: 6762 DEMKO DRYWALL CO, INC 419 S MARSHALL AVE EL CAJON, CA 92020 Date: 05/28/20 g<~)X JI INVOICE In: 9:40 Truck: 9999 Out: 10:05 Container: Route: 03014 Origin: 030 COUNTY Un CoJ1111odi ty Units Rate 14 MIXED C & D 1.87 92.00 per TON [Gross(Inl: 21,920. lbs Man Wt Tare 18.180. lbs Scl#5 Extended Charge 172.04 Net: 3,740. lbs] TOTAL DUE 172.04 C. river \/1 I r -•. ! •¾-/ ,, ' -·· \ '. r · i '· I : 4/7 9020-608 ESCONDIDO RESOURCE ECOVERY AND WAITE TRANe,e:R IEIIVICE "We'll Take Care of It" Construction & Demolition Diversion Certificate Received at :Escondido Resource Recovery Processed At : SRR Lemon Grove, CAD Date: Sl'l9J)() COi San Marcos, CA yo!) Customer: --------Ticket# -#ODS--§ \JD X ~ I Project: Number/Description ______________ _ Total Tons Received: lxbons Diversion Percentage: b6 % /'' ~·· --~") ~ -,,"-··---. Scale house Operators Signatu~:-~ .. __ ·· Tois certifies that the company listed above has utlllzed S:-EGCQ_facillty to divert construction demolition materials in accordance with LEED requirements. The diversion tonnage is based on an overatt tonnage percentage of the respective EDCO facility. MOODY'S EL CORAZON RECLAMATION POBOX969 BONSALL, CA 92003 (760) 433-3316 • FAX (760) 433-6691 Id 1 I l L e: ic 7 57 I . .J08 LOCATION \I / t :· ,, i I • . r PU TRAILER FLATBED SIGNATURE Alt bins due upon presentation unless olherwlsa arranged in advance. Open accounts aubject to 1 112% month, charge after 30 days unpaid balance. ENO DUMP T& T • >" ; * ' . i ' . I i , I • • ~ ~ ~ • . ~ ~ l J s \<SC)O-:;" I Pm1$t pmze·: -~ 13 ,7 I-DE rvt. ro 15 : l){;rn.TNJFK!)./)~111/L i MOODY'S It nltrrespon/he'for Jtfr"t:ge 10 l't/Q 2 4 vehicle whne being loaded or unloaded in .).. " ~~ l ; JOB COPY 275069 SANCO Resource Recovery 6750 Federal Blvd. Lemon Grove, CA 91945 (619) 287-7555 customer: 0567 Ticket: 2530 Date: 06/10/20 DEMKO DRYWALL 419 S. MARSHALL AVENUE EL CAJON CA 92020 CARLSBAD Rate In: 13:44 Out: 13:45 68.00 per TON Truck: Container: Route: Origin: INVOICE 5397/5397 G 02034 020 SAN DIEGO 1301 f) Extended J-t·o fj <..·-(.-Charge ...,..-r · .) .._) 234 . 60 Commodity Units 34 CONSTRUCTION/ DEMOL 3.45 [Gross(In): 25,360. lbs Scl#l Tare 18,460. lbs Stored Net : 6,900. lbs] TOTAL DUE 234.60 Construction & Demolitlon Diversion Certificate --Diversion Percenta9.e 68% This cert~ies that the company listed above has utilized an EDCO facility to divert construction demolition materials in accordance with LEED requirement. The diversion tonnage Is based on an overall tonnage percentage of the respective EDCO facility. / I VICENTE RUIZ Driver A 111111111111 Tran No 4::W 117 615!2020 11 :!46:34 A ALL WAYS METAL RECYCL.'ING 1425 N MAGNOLIA AVE \ EL CAJON.CA 92020 Phone 619~390-6637 RC-260418.001 J-0197' ... PAID BY C Veh Plate Material GroH Tare Net 611 8/XWIRE 16,060.0 14,940.0 1. 120.0 $/Lb Shk¾ Amount 492.60 0.220 o.· · ,;,.:r,r;, ~;-~ Pf<V I~ l"l<f•.:t::: FL•>:TI "TE C"-IL Y b,<EC• (lf'l (•)Mi,l:W ,· ~IAPfiElS, .-'I~·, :,((,AP ~i: r,1.1. f1~.w . .e .. Tl-1AT 14":C,C, r,:, llE ;,;,t.n,c, £,f ,:._IR EMPl.(•YfcE. Will r<E, ,eve 1, LL'·: •'llH'lll(\: lH.ON ,~ Ml\fERf,1111$ • .:,r,rec>AI.C•~( rv EC P1.,:,.1:~r,A1ll,V'/El(~tr, f<; ~1,,w,J(, THI~ OE(IEP'I ,.:Al ... :hN&:tE'r•-E TfoEF...,;T Wf!l(>tfrM• ;JEf< 1:ERTIFK-.TI! lH1: I::. Tc• ,:~TIFY Ul Jtt"' fvMW" •Jili:..·n~1.: 'lf,il~'I '• •i ~~w. m,-.-:1Jwd, « "vl.lf'ltt1 Lv • .:J wc,tc,lffld\M', "~"'" •\I••• 1'. v11 ths 4.eRt1cM• ... ,au, .. a r i:o.;nttd > ~lfMl'Yura-: LW.k·, • .,)$r,r~.,tl4,1 Uy (~w-1 t.._.,.,.nun,:,nv~ Stt.:bCtr1 12100) ur C11viS1«1 ~ rd thi\ ,:t111t~r•a~ llfl,,1 Prof81\tot"'i\ i: '"'-,., ~r,11·~t«vd ~ .,. c~,M•4l vr •••••~·•u•1ner,t f;l4f1Jard-. ot .-.. Cdlll<A1nc...,.1m.tiY1Fw<1an<1"0".....,• , f:<H.L ,:f' .;,. LE· I --,¥1 IIW I .. n It•-(<t <IO'....,.,. r,;p_,_, of.,.,. nl<ll,111~ <li,G<nt ... ~ ""'"'" did hii••.-ltw r,;ti k; Mt•·~ ... dll!11\r"11u,1tr»l◄dl/Jr(t&'<At.,ar.t1r., <• o»~Ndt;a,,.,, t~-.. «.&tM1-1t\lll'\al tvt ,.Ylf,1HCh«t1,y r~IHWd. I Hl.,..:i .:,,n,,,,i;r, WI. t.:1 H•i R11: 'Jt ll)J r:«it♦r ti.A.£, ~E;:-. Al:-f<EEMl:1.Jl · ..1..-"'' 1nJc.rn1y ar,.; 11""1 t,.,Yil ha,,~• lrolffl .!arr_., d-ruonJ~ a,,111 IJl:Allll•1. ,n.:Wr"aJ r•~.....U. illl.;,n•v• r ... -;. ";iJ11r111 ft,.11 "" iw-,;.xh ,,t«ry , . ...,,.,,,~ hot-..-.i dr•W ">)t'hS fa:. b.; f<-;j)<<ISloi. k• ~•t~ I~ ,.,,hi.to dlllllfl i.nob:lto9. EXECUTED AT EL CAJON, CA 6/5f20,;, 1 received from ALL WAYS METAL RECYCLING !he amountof · x. ___________ _ Seller's Signature PRINT NAME Deputy Weight Master WEIOHED AT LINDS 14'.!5 N MAGNOLIA AVE EL CAJON. C'A 9'.!0'.!0 THANK YOU. 3-day hold ticket must be redeemed within 90 days. r-- t ' t f r I t f·· I I ' t· r ! _. t· I I . I I I f t I I f ,, ~ I f I I I I I ~ I I l • . . ... ---·-·· ...... ---·---1 MOODY'S i • F.L CORAZON RECLAMATION 1 W~r , POBOX969 BONSALL, CA 92003 (760) 433-3316 • FAX (760) 433-6691 J08L TION PU TRAILER 3 4 5 ' / /c17) #LOADS X PRICE SIGNATURE All billa due upon pre&entatlon unleas otherwl.se arranged In advance. Open aocounte subject to 1 1f.l'II. month, charge after 30 days unpaid balance. 6 JOB COPY 7 ~ IS 3 1)2 TIME ./ 8 9 10 I OTHER CHARGES $ /JZ) ~ .277111 ~ J ~ l --- MOODY'S .f EL CORAZON RECLAMATION POBOX969 BONSALL, CA 92003 l I i I t (760) 433-3316 • FAX (760) 433-ti691 FLATBED 3 4 5 ; /0-0 #LOADS X PRtCt: SIGNA RE All bills due upon p(9&81ltation unless oth81'Wisa arranged in advanoe. Open accounts subject to 11fl% moolh, charge after 30 days unpaid balance. 0 E T&T 6 7 8 9 10 OTHER CHARGES $ c:100 - TOTAL: ~:d' /g TRUCK#. MOODY'S Is not responslb4e tor damage to vehlc:le whffe being loaded °' unloaded In yard. JOB COPY 2.77212 r ~--. I' r ~ ~ I t I l 1. i I I l: r i I I· ~ t r I i I· I ~ 1, I JOB LOCATION PU TflAILER I LOADS SIGNATURE MOODY'S EL CORAZON RECLAMATION POBOX969 BONSALL, CA 92003 (760) 433-3316 • FAX (760) 433-6691 TIME ENOOUMP T&T 3 4 5 6 7 8 9 10 X $:;;no TOTAL All bills due upon presentation unless otherwise arranged in adv11nce. Open accounts subject to 1 112% month, charge after 30 days unpaid balance. MOODY'S Is not responsible for damage to vehicle while being loaded or unloaded In yard. JOB COPY 277389 ' g i f I l l I ...1 J ' -; ' ·1 1 ! ·i ·J } j ' . . I, MOODY•s EL CORAZON RECLAMATION POBOX969 BONSALL, CA 92003 (760) 433-3}16 • FAX (760) 433-6691 JOBI OATE RESIDENCE TIME -L.)e'r" \,,( 0 , citv OF ORIQIN A \ { (. / I \. C :r ~ ::iC I' I JOSLOCATION --=-------------- PU ILER FLAT8ED BOBTAIL 3 4 5 I loo SIGNATURl: All bHls due upon presentation unless otherwise arranged In adVance. Open aCCOIJnll subject to 1 112% month, charge after 30 days unpaid balance. 10-WHEEL T&T 6 7 8 9 10 0 OTHER CHARGES $ I()() TOTAL #I TRUCK It MOODY'S Is not responsible for damage to vehicle WhHe being loaded or unloaded In yard. Qft_ J08COPY 278622 . l ,c .,_ I ~ (city o f Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN 8 -59 Development Services 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 t o 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 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. ______________ Project Title RAF fu.sion for Alphatec Spine Project Address 1950 Camino Vida Roble, Carlsbad, CA 92008 Applicant Name Tarango, Andrew APN 212-093-05, 12 Owner Contractor Last First 0 0 Applicant Address 13280 Evening Creek Drive, Ste. 125, San Diego, CA 92128 --- Phone _._(_8_5_8_,).___7_9_3-_4_7_7_7 ______ E-mail Address Applicant Mailing Address (if different than project address) Project Type (check all that apply): Residential Commercial □ ■ andrewt@sca-sd.com Public Building □ Architect Other -0 Industrial □ Brief Descripti on Demolition of interior non-structural walls, doors, frames, ceilings, lighting, mech.ducting., plumbing. New trenches and underground plumbing. Project Size 7,635 s.f . Estimated Cost of Project$ ------------------(square footage) Please check the appropriate box: ~ plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction. D I 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 MANAGEM ENT. Acknowledgement: 1 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. // lilJr' Print Nam e __ A_n_d_r_e_w_R_._T_a_r_a_n_g_o _____ Signature ________ ,. ______ Date 2/28/2020 Page 1 of 4 Rev. 1111211 o PART 1 Complete, obtain signature, a nd submit this form when applying for a Building Permit. Note: Permits will {cont'd) not be issued without a completed Construction Waste Management Plan. DEBRIS RECYCLING ESTIMATE: SECTION A Permit No. ____________ Project Title Project Address 1950 Camino Vida Roble, Carlsbad, CA 92008 Applicant Name Tarango, Andrew Last First RAF fu.sion for Atec APN 212-093-05, 12 Phone ( 858 ) 793-4777 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. Material Type Complete this line of the coble only If only using WASTE MANAGEMENT roll-off bins. Mixed c&0 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 Goal: the diversion rate shall be 65% by weights of debris. A B C Estimated Waste Quantity (tons) 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 To meet 65% Diversion Requirement (estimate) _________ x 0.65 = ____________ tons Total Estimated Waste from above Minimum Required Diversion Contractor/Owner Signature ~~ Date Page 2 of 4 Rev. 11/12/18