HomeMy WebLinkAbout1775-2021DocuSign Envelope ID: 89F68677-D85B-4775-84FE-860B9696C870
CONSTRUCTION & DEMOLITION RECYCLING PLAN and DISPOSAL REPORT
City of San Luis Obispo Utilities Department s 879 Morro Street, San Luis Obispo, CA 93401 • 805-781-7215
Please read this form carefully. The goal is to clearly document thatyou have recycled a minimum of 65% of C&D materials, per California State regulations.
Prior to Project: Completely fill out Section 1 and Section 2 (if applicable).
Section 1: To be completed by all Building Permit Applicants
Application Number: Site Address: Type of Project:
BLDG-1775-2021 3535 Higuera Street Tenant Improvement - Cannabis Delivery
Owner's Name: Contractor's Name: Square Footage:
Stephan Kennedy Snyder Custom Construction Inc. LIC#998460 612
805) 452-6747 200,000
Using a Certified Roll -Off Company exclusively? Y / N Self -Hauling? Y / N YES Estimated Fine for Failure to Comply (2% of total EPC):
IF YES WHICH ONE?
IF YES, COMPLETE SECTION 2. 4,000
Applicant's Name: (Printed) (Signed) Date:
Stephan Kennedy 9/28/2021
Section 2: To be completed if self -hauling.
If self -hauling, lease list the recycling facilities where the waste will be taken.
Concrete and Asphalt: Wood: Santa Maria Transfer station Cardboard: Santa Maria Transfer station
Gator Crushing and Recycling or Chicago Grade and landfill - Atascadero or Chicago Grade and landfill - Atascadero
Drywall: Santa Maria Transfer station Metals: Santa Maria Transfer station Other: Santa Maria Transfer station
or Chica o Grade and landfill - Atascadero or ChicnoQ_Grade_ Atascadero or Chicago Grade and landfill - Atascadero
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
sip_n off. 1 understand that failure to do so may incur a penalty of 2% of
total proiect valuation.
Oaau ftn" by:
Sign)
9/28/2021
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 Ap2roved: Reviewed/Approved by: EX
Proiect Exempt:
Plan Denied: Date: Z - 2