Construction and Demo Acknowledgement FormJanuary 2020
CITY OF CYPRESS
BUILDING AND SAFETY DIVISION
Construction & Demolition Diversion Program Acknowledgement
Project Address: Permit No.:
Name of Responsible Property Owner and/or Contractor (Specify) and contact information:
Please read and sign below to signify you understand this information.
1. Pursuant to Chapter 12 Article 8 of the Cypress Municipal Code, a security deposit amount of no less
than $1,000 was paid on ________________ to the City to guarantee compliance with the 2016
California Green Building Code construction debris diversion requirements.
2. You have been provided with the “Contractor’s Guide to the Construction and Demolition Debris
Materials Questionnaire”, a step-by-step manual on how to successfully complete the reporting process.
3. Failure to comply will result in forfeiture of entire deposit amount. Construction debris sent to a
processing facility as mixed solid waste is classified as trash and does not meet the recycling or reuse
requirement.
4. New Construction or Non-Residential: Prior to any inspections, a waste management plan and
materials questionnaire must be completed and submitted via www.cypress.wastetracking.com for City
approval. Contact the City’s solid waste program coordinator with any questions at 714-229-6748.
5. The City’s franchised trash and recycling hauler is Valley Vista Services. Pursuant to Chapter 12
Article 8 of the Cypress Municipal Code, using the waste hauling services of a non-permitted or non-
franchised hauler will result in automatic forfeiture of deposit amount.
6. To rent temporary construction bins, call Valley Vista Services at 714-380-5450. You must notify
Valley Vista that you have construction waste that needs to be recycled.
7. Before your final building inspection, submit the completed waste management report (including
evidence* the construction debris was recycled or reused) via www.cypress.wastetracking.com for City
approval.
*weight tickets or recycling reports
Name of Company Providing Dumpster/Roll-off Bins:
Valley Vista Services Self-Haul:
Property Owner or Contractor’s Signature:
Date:
Type of Project:
□ – New Construction
□ – Demolition/Remodel
□ – Addition
Type of Project:
□ – Commercial
□ – Mixed Use
□ – Residential
Disposal Type Admin Fee:
□ – Self-Haul- $320
□ – Franchise Hauler- $80
□ – Combination- $320