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City of Modesto Community and Economic Development Department Building Safety and Neighborhood Preservation Division Oscar Diaz, Chief Building Official CONSTRUCTION WASTE MANAGEMENT (CWM) ACKNOWLEDGMENT Project Name: Permit Number Waste Hauling Company CWM Plan Acknowledgment The Foreman for each new Subcontractor that comes on site is to receive a copy of the Construction Waste Management Plan and complete this Acknowledgement Form. I have read the Waste Management Plan for the project; I understand the goals of this plan and agree to follow the procedures described in this plan. Date Subcontractor Foreman Signature Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I certify that the features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 11ofthe California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Signature: Company Date Address License No SIGN SIGN ---PAGE BREAK--- City of Modesto Community and Economic Development Department Building Safety and Neighborhood Preservation Division Oscar Diaz, Chief Building Official City/State/Zip Phone In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at