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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) WORKSHEET Project Name: Permit Number Waste Hauling Company Construction Waste Management (CWM) Plan Waste Material Type Diversion Method: Projected Diversion Rate Commingled and Sorted Offsite Source Separated Onsite Asphalt Concrete Shotcrete Metals Wood Rigid Insulation Fiberglass Insulation Acoustic Ceiling Tile Gypsum Drywall Carpet/Carpet Pad Plastic Pipe Plastic Buckets Plastic Hardiplank Siding and Boards Glass Cardboard Pallets Job office trash, paper, glass and plastic bottles, cans ---PAGE BREAK--- City of Modesto Community and Economic Development Department Building Safety and Neighborhood Preservation Division Oscar Diaz, Chief Building Official Alkaline and rechargeable batteries, toner cartridges, and electronic devices Other Other Other 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 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 SIGN