HomeMy WebLinkAbout1262 BUENA VISTA WAY; ; CBR2022-3162; Recycle{city of
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN ·
B-59
Development Services
Building Division
1635 Faraday Avenue
442-339-2719
www.carlsbadca.gov
APPLICABLE TO NEW CONSTRUCTION, ALL RE SIDEN T IA L ADD ITIONS AND ALTE RATIONS AND
COMMERCIAL ADDITIONS AND ALTERATIONS OVER .$200K. If you have question·s 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 se.;f-hauling, Republic
Services or approved haulers must be used for al l construction ro·ects within the Cit 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
Project Address I 2. G, '2--fs V e.. I\ ~-V----GL~~-4--__ APN J.!i_f,/2-02. 500
Applicant Name .f ug,_/\±:R... s CY(} ~.:=,±o 0---C□tor Other □ Last First
Applicant Address I '2.(oo (svL-il)~-3°.fu... wc.,, t Car-I sbe-..d ~ °; 7..L}o ~
Phone ( rfD ) b /'3-~'5:0/ E-mail Address e_._,,...,.,, 6.L.Q..Vl ~-~ (c. t, o -o . c o.H'l
Applicant Mailing Address
{if different than project address)
Project Type
{check all that apply):
Brief Description
Residential
~
Commercial
□ Public Building □ Industrial □
Project Size __ I:~_'i...._'2-""--______ Estimated Cost of Project $ __ 51_0_~~0_0_0 __________ _
(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 list ed
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 £ (-1\..e....S,:::\-o £u'4i\.k5 Sign ature ~-'-#<-~---~h,z,-----=-___ Date
Page 1 of 3 Rev. 05/22
CBR2022-3162
l ,.
PART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final
building approval.
DEBRIS RECYCLING REPORT (ACTUAL):
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 li sted 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. C(s (L 2.o'2..'2.. -3 /" J... Print Name .f-v112.v1-/<.~ d J --------~~~---------<
Address J-'l.G,7-[1v.(;l.o., VN,b,,.. -~)' Date -<f~zo2..
Use this Final Log below to track loads of materials as they leave the job site.
0 □SAVE RECEIPTS□□
lndiccjte FI NAL 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:
01/05/2018
//,. l-"2.J
3 . '2..7..
Material Type
Concrete (broken)
Actual Amt
Reused or
Salvaged
Diversion Rate Achieved I
Total of columns A + B
Actual Amt
Recycled
5 tons
••
-:;-. 5
Actual Amt
Disposed in
Landfill
/. '"Z.5
=
Total of columns A + B + C
Destination Facility
(N ame, Address, Phone)
Palomar Transfer Station, 5960 El
Camino Real
-760 603-0153
'?-t; <'.65%
% ~65%0
DIVERSION
Contractor/Owner Signature_~4--.. ... 4..._.._/'-: ____ ~ _______ Date
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
Return completed form and documentation to:
City of Carlsbad
Building Division (1st Floor)
1635 Faraday Avenue
Carlsbad, CA 92008
Rev. 51612022
-------=--
MOODY'S
EL-CORAZON RECLAMATION
PO BOX 969
BONSALL, CA 92003
(760) 433-3316 • FAX (760) 433-6691
P.0 JOB#
CASH CHECK CHARGE COMMERCIAL
NAME
CITY OF ORIGIN
J OB LOCATION
TRAILER .' rLATBED BOBTAIL
PU
MATERIAL j
LOADCCUNT 5 1 2 3 4
'
# LOADS X PRICE
SIGNATURE . t f n unless otherwise All bills due upon presg a l~ccounts subject to
arranged in advance. pen a s unpaid 1 1/2% month, charge after 30 d Y
balance.
DATE
RESIDENCE TIME
110-WHEEL END DUMP \T & T
6 7 8 9 10
OTHER CHARGES
$
TOTAL
TRUCK#
\
MOODY'S is not responsible tor damag~ to
vehicle while being loaded or unloaded m
yard.
... .. !I ~ .... ~ ,f";; ·~-~ 'l:
. ._ ;'V, < ,j J
'!;, I, > .,.. ~""
JOB COPY •·
WEJGHMASTER CERTIFICATE c+)
MOODY'S
EL CORAZON RECLAMATION
P.O. BOX969
BONSALL, CA 92003
(760) 433-3316
THIS IS TO CERTIFY that ihe following described commodity was
weighed, measured, or counted by a weighmaster, whose signature is
on this certificate, who is a recognized authority of accuracy, as
prescribed by Chapter 7 {commencing with Section 12700) of Division
5 of the Carnomia Business and Professions Code, administered by
the Division of Measurement Standards of the California Department of
Food and Agriculture.
P.O.NO.
SOLD TO
ADDRESS
JOB LOCATION
C.O.D. I CHG.
TONS/CUBIC YDS.
1
2
3
4
5
6
Responsibility and
ownership of material
belongs to consignee
when loaded on truck
!JOB NO.
TRKOWNER rR~NO., DRIVER
ITEMS
D D.G. FILL DIRT
0 BASE Class II Class Ill
O'SAND SE50 SE 30
0 TOPSOIL
0 ROCK 318 1/2 3/4 1 1-1/2
0 ENVIRONMENTAL FEE
GROSS TONS I
TARE TONS
NET TONS
Loaded at
3210 Oceanside Blvd.
Oceanside, CA 92056
DATE
ARRIVE PLANT
LEAVE PlANT
ARRIVE JOB
PlANTTKNO. LEAVE JOB
UNIT PRICE AMOUNT
3"
TOTAL ' / -' I
TAX --.. -
TOTAL AMOUNT c/
PREVTONS _______ _
TOTAL TONS _______ _
,-
'
Moody's Outbound Material RESALE □YES ONO
Moody's __________________ _ DeputyiWeighmaster
,_
-
All bUls due upon presentatron unless otherwise arranged in
advance. Open accounts subject to 1-1/2% monthly charge
after 30 days unpaid balance.
Not responsible for damage resulting from
delivery made inside the curb or property line.
i
RECEIVED BY ____ 1_· -----:-1_· ----------
I
1[
-! I
1111111111111111 II
Cm,-tomer Copy # 1
fo .. l·et# 1954 73
Gross Tara
SHEE1 llLUMltfUM
10300 101GO
Gros~ \,-Veighfnast~r Kebe'/ K
Tait'! V:.i1:cist1::13Stl;)I ~<11lse·; h.
Ernesto Fuentes
Printed oa Sawrday
11/1112023
09:56:07AM
Weight IN ; 0'it5:5':55 AM
Waight OUT ; 09:55:~9 AM
Started by 1-\eh.,.y K
Paid by
ffat Price Amount
HO
Total--> s.39.20
Pay by Cash: $20.00
\\\ \1-\
56i95F3
i250 8L:ei":3 Vista '{;113}' (;01d:i\::3(l CA Sl2008
Add_t·-e:::a
Ownership: i llernl:Y~• state tnat I am the lawful owner of tfle
material described h-emn, mot I have a right to s-elt same, ttiat all
State red,amption n,ateri1il listed 1:51n fc:Ct \/ahd State-redemption
material aM that for payment re-ceive-d in toll, herett-1
acJmov'Jledge(l, I sBll 1md co1we'J' trHe or :.ilme to LEE'S ME1At
RECYCl.!NG,
II
X
HDLllS of :'Jp..ration
tJon,j3,1, Thn., Fr1d,L· ~;,-n,,-; ]l)p:-, . ,
Satun1@}' 3,nn-1 pr(!
\\:e1gh1,.;;1 '~'i De.put; ':',t:t(Jh:11.a1te1
Grn% ~"iBighM3,;tiir K81,;•J'/ K
TMe •;·,,:ei:Jr1l:,ia;:;;tN, hfiS~:r r:.
I
1111111111111111 I
Cuslomer Copy # 1 -PAm
r,, ;. et# 203398
Gross
Print~d on Friday
03i12ll{)24
12:4·9:)TPM
VVeight lN '. 12;23-:51 PM
Weight OUT: 12:49:32 PM
Started by Cashier
Paid by Cashier
!-.let Price Amount
llGHl IRON
12380 10430 1900
Gros$. \Ne1gfo·r21ster Cash1e1
TartJ 'JVe19h;:-:c,as!t11 Gashie1
Total--> s.57.00
Pay by Cash: $57.00
Ernesto Fuentes 669915F3
C:u.stOll}oH' Na.mi) IU/t.ic.r.nae V•h/Plat&
1260 BL11;;na Vista V\'ay Calisbad CA. ::12008
Addr·ea;a
Owme-rship: I heretJ~· state t::iat l am the lawful owner of the
material describf!d hernri, that r hilve a right to se-tl sa:me, that a!:I
State redemr•tic,n mater:ial listed is ii~ f11,ctvahd St1te red~mption
material and that tor :payment rece•iVf<ri ifi fufl, here,b-)!
acknowledgeca, I se-JJ <'Hi<J eonve)I trtl:0 of s.ame to LEE'S METAL
RECYCLING,
X
Hours cf Op .. rat1on
Monday Thm Friday 8am-4:30prr:
Saturday 8a:-n-1 pm
1}/eigh~d t:y Oeputi ·:Veighmaster
G1 ,:iss \\'eighMa5ter • Cashier
Taie V)eighf-.1a5tF.f Ci.iSllii:[
Tar1:1 1,VeighMaster :3ign
c:, 4 Ticket # : 2 6 7 4 3 8 8
PALOMAR TRANSFEP
5960 EL CAMINO REAL
CARLSBAD, CA 92008
Weighmaster: IN -martios3 OUT -roacara
(760)603-0153
000999 -CASH AND CHECK CUSTOMER
ADDRESS
carlsbad, CA 92008
Contract: RESIDENTIAL-Yr. 2
GROSS 10,820
TARE 10,020
NET 800
Tracking Qty: 0.00
Qty
0.40
Unit Description
TN MSW
Origin: OCEANSIDE
Signature:
Scale In
Scale Out
100%
In: March 22, 2024
Out: March 22, 2024
Vehicle: CD
Ref: 10,820//140CC
BOL:
INBOUND
CASH
Rate Extension
$96.28 $55.00
Tax
$0.00
Total
Paid
Change
.EDIT CARD-SCALE
2:10 pm
2:28 pm
Total
$55.00
$55.00
$55.00
$0.00
V
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