HomeMy WebLinkAboutPlease_DocuSign_Recycle_planDocuSign Envelope ID: 969DF497-lC21-4308-A03D-DDE4E5080687 F_
CONSTRUCTION & DEMOLITION RECYCLING PLAN and DISPOSAL REPORT
City of San Luis Obispo utilities Department • 879 Morro Street, San Luis Obispo, CA 93401 • 805-781-7215
Please read this form carefully. The goal is to clearly document that you have recycled a minimum of 63 % of C&D materials, per California State regulations.
Prior to Project: Completely fill out Section I and Section 2 (if applicable).
Section 1: To he completed by all wilding Permit Applicants
Application Number:
Site Address:
Type of Projcet:
BLDG-1775-2021
3535 Hiquer-a Street
Tenant Improvement - Cannabis Delivery
Owner's Name:
Stephan Kennedy
Contractor's game:
}
Square Footage:
612
Owner's Pho
Cont actor's Phone:
Estimated Project Cost:
Using a Cez�ifaed Roll -Off Company exclusively. N
Self -Hauling'? Y
Estimated Finc for Failure to Comply (2% of total I PC):
IF YES, WHICH ONE?
IF YES, COMPLETE SECTION 2.
Applicant's Name: (Printed) (Signed)
Stephan Kennedy Date. 9/30/2021
S+tPud�
Section 2: To he completed ifself-hauling.
If self -ha ulin , Please list the recycling facilities where the waste will be taken.
Concrete and Asphalt:
Wood:
Cardboard:
Drywall:
Metals:
Other:
I understand that I must produce receipts listing tonnage of all materials
leaving the project site, regardless of destination or method of removal.
I certify that I will communicate this plan and requirements to all
contractors and other personnel who may be involved in disposal of
materials from this project, and inform them that they must provide
receipts for all recycling and trash disposal.
The final permit and all waste receipts must be presented prior to final
sign off. I understand that failure to do so may incur a penalty of 2% of
total project valuation.
—DocuSigned by:
S+t.� J�
9/30/2021
(Sign) (Date)
• ALL TONNAGE LEAVING SITE MUST BE ACCOUNTED FOR
ON THIS FORM
• FAILURE TO RECYCLE AT LEAST 65% OF MATERIALS CAN
RESULT IN A PENALTY OF 2% OF PROJECT VALUATION
For Utilities Office Use Only
Plan Approved:
lteviewedlA roved by:
Project Exempt:
Plan Denied:
Date: