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Home My WebLink About2640 JEFFERSON ST; ; CBR2022-0489; Recycle• ~ {'cityof Carlsbad ~ o,pment Services CONSTRUCTION wl!s f. -. ... . .. -. . . ...... . : .. t CE.\ Bwldmg D1v1S1on MANAGEMENT P ?O'l.3 1635 Faraday Avenue B-59 fl_?R t 6 -442-339-2719 ._, Of cA~LS13~~-ww.car/sbadca.gov ~\\~ n1NG o\\f\SIO APPLICABLE TO NEW CONSTRUCTION, ALL RESIDENTIAL ADDITIONS AND ALTERATIONS AND COMMERCIAL ADDITIONS AND ALTERATIONS OVER $200K. If 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__yc>u are self-haulirlg, ReE>_lJ_blic Services _or approved haulers must_b_g used for_a_l!_construction prolli!S 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. CBR2O22-O489 Project Title 2642 Jefferson Street ProjectAddress2642 Jefferson Street, Carlsbad, CA 92OO~PN 155-271-19-00 ApplicantNameCalderon Luis □ cr:;r' er □ ------ Last First AppllcantAddress 2642 Jefferson Street, Carlsbad, CA 92008 Phone .lZ._6~59-247~----_E-mail Address permits@snapadu.com Applicant Mailing Address PO Box 2065, Carlsbad, CA 92018 (1/ different than project address) Project Type (check all that apply): Resldential 0 Commercial □ Brief Description Addition of new 484 square foot ADU Project Size 7 49 Estimated Cost of Project $270,000 (square footage) Please check the appropriate box: > E--0 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 Luis Calderon __ .-_____ Signature L~ ~O"flv Date ___ , 4/25/23 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: SECTION A Permit No. CBR2022-0489 Project Title 2642Jefferson Street Project Address 2642Jefferson Street, Carlsbad, CA 92008 APN 155-271-19-00 Applicant Name __ C_a_l_d_e_ro_n _______ Lu_i_s ______ Phone ( 760 ) 259-2476 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. A B C Material Type Estimated Place a (0) check Place a (0) check next Place a (0) 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 roll-off bins. Mixed C&O Debris □ □ □ Asphalt & Concrete C1 □ □ Brick/ Masonry/ Tile □ □ □ Mixed Inert Debris C1 □ □ Cabinets, Doors, Fixtures, □ Windows (circle all that apply) Carpet □ Carpet Padding/ Foam Cardboard □ Ceiling Tile (acoustic) Drywall (used, new, scrap) 0.1 □ Landscape Debris (brush, trees, stumps, etc.) No dirt. Unpainted Wood & Pallets □ □ Roofing Materials □ □ Scrap Metal □ □ Stucco _ _O __ □ _EZL ---------- Other: □ □ □ TOTAL ;= SECTION C To meet 65% Diversion Requirement (estimate) -~1~1~ ___ .x 0.65 = ___ 0_._7_15 _____ tons Total Estimated Waste from above Minimum Required Diversion Contractor/Owner Signature L~ ~01,\., Date 4/25/23 ---------------- Page 2 of 4 Rev. 05122 ---------------------- PART 2 Complete before final inspection, obtain City Approved hauler receipts and return prior to final building approval. 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. CBR2022-0489 Print Name Danielle Boulila Address 2642 Jefferson St Date 10/23/2023 -------------------------- Date Exame_le: 01/01/2020 06/01/23 ---- 08/09/23 09/03/23 10/12/23 10/24/23 Material Type Concrete (broken) Mixed Debris ------ Mixed Debris -------- Mixed Debris Mixed Debris Mixed Debris A Actual Amt Reused or Salvaged Attach the following documentation to this Report: Original recycling weight tickets, landfill weight tickets B C Actual Amt Actual Amt Destination Facility (Name, Address, Phone) Recycled Disposed in 5 tons Landfill Palomar Transfer Station, 5960 El Camino Real -760 603-0153 1.54 tons Palomar Transfer, 5960 El _______ Caffilrn1&aill60)603-015;L __ 2 66 t ns Palomar Transfer. 5960 El _:_0 __ Camino Re.aL(Z6.0.)6.0.3d)153__ 1.13 tons Palomar Transfer, 5960 El 1.40 tons Palomar Transfer , 5960 El i 7 -1 .98 tons Palomar Transfer , 5960 El 7.71 tons Total of columns A + B + C % DIVERSION Date 10/23/2023 Return completed form and documentation to: City of Carlsbad Original donation receipts with photos and/or itemized descriptions Any other relevant information to support Recycling Report Building Division {1st Floor) 1635 Faraday Avenue Carlsbad, CA 92008 Page3of4 Rev. 04/22 PALOr~;.1.K T~:<.ANSFER 5960 EL CAMINO REAL CARLSBAD, CA 92008 (760)603-0153 000999 -CASH AND CHECK CUSTOMER ADDRESS carlsbad, CA 92008 Contract: RESIDENTIAL-Yr. 2 GROSS 20,040 Scale In TARE 18,080 Tare Out . NET 1,960 Tracking Qty: 0.00 Qty 0.98 Unit Description TN MSW Origin: CARLSBAD Signature: 100% 'c4 Ticket #: 2616847 Weighmaster: diazadl In: Out: Vehicle: Ref: BOL: INBOUND CASH October 25, 2023 October 25, 2023 Al04498 Rate Extension Tax $0.00 $96. 28 $94.35 Total Paid Change .EDIT CARD-SCALE 11:22 am 11:22 am Total $94.35 $94.35 $ 94. 35 $0.00 V