HomeMy WebLinkAbout2701 LOKER AVE W; ; PC2021-0009; Recycle{city of
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN
B-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 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 Carl~bad.
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. PC2021-0009 Project Title
Project Address 2701 Loker Ave
Applicant Name Ciurej Courtney
Last
Applicant Address 6205 Lusk Blvd
Phone ( 858 l 587 -0900
Applicant Mailing Address
(if different than project address)
Project Type
/check all that apply):
Residential □
First
E-mail Address
Commercial
[l]
Brief Description Tl -new offices and finishe_s ___ _
Pacific Western Bank Palomar Crest
___ APN
Contractor Architect Other
[l] □ □
courtney@crewbuilders.com
Public Building □
Project Size 15,955 Estimated Cost of Project$ 1 ,200,_000
(square footage)
Please check the appropriate box:
I ✓ I I plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction.
I ✓ I 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 Co_urtne_y_C_i_u_r_eJ_· ______ Signature, ____ •_··_"""_····_..==":'._ ____ Date
3/15/21
Page 1 of 3 Rev. 2.10.21
DEBRIS RECYCLING REPORT (ACTUAL):
SECTION A 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. PC2021-0009 Print Name Courtney Ciurej
Address
SECTION B
-------
2701 Loker Ave Date 3/ 12/21
Use this Final Log below to track loads ofmaterials as they leave the Job site.
@@SAVE RECEIPTS@@
Indicate FINAL quantities in ton:,for each material and save receipts an<! documents from facilities where material is taken.
Additional Project Log pages· are available if necessary. Use City Conversion Table to convert volume to tons.
Date Material Type
A B C
Actual Amt
Reused or
Salvaged
Actual Ami
Recycled
Actual Amt
Disposed in
Landfill
Destination Facility
(Name, Address, Phone)
Example:
01/01/2020
Palomar Transfer Station, 5960 El
Concrete (broken) 5 tons -J--Camino Real
__ -_(760) 603-()153
---t f
---+-----1-~~~
Diversion Rate Achieved I = %
DIVERSION
~65%□
Total of columns A + B Total of columns A + B + C
Contractor/Owner Signature _____________ _ Date
Attach the following documentation to this Report: Return completed form and documentation to:
Original recycling weight tickets, landfill weight tickets
Original donation receipts with photos and/or itemized descriptions
Any other relevant information to support Recycling Report
City of Carlsbad
Building Division (1st Floor)
1635 Faraday Avenue
Carlsbad, CA 92008
Page 2 of 3 Rev. 2110121