OFFICE OF THE CITY BUILDING OFFICIAL COPY

OCBO-F-001 (Revision 2: October 27, 2022)

Oceo-e-FORM 01

Republic of the Philippines

Province of Bulacan
City of San Jose del Monte

OFFICE OF THE CITY BUILDING OFFICIAL

NAME OF APPLCANT: DATE: uIME:

LOCATION/ADDRESS:
NAME OF APPIICANT: NO. OF UNTS:
APPLICATION NO:

LUST OF DOCUMENTS: FOR PERMIT APPLICATION

A. OFFICE OF THE CITY BUILDING OFFICIAL
1. Accomplished application forms (All signatures and seal original)
2. Accomplished Unified Forms (Al signatures and seal original)
3. A. In case the applicant is the registered owner of the lot.
I. Certified True Copy of Lot Title
. Tax Declaration
I. Updated Real Property Tax Receipt
8. In case the applicant is not the registered owner of the lot.
I. Duly notarized contract of lease or absolute sale or contract to an authority
to construct from the LOT owner
1. Certified True Copy of Lot Title
1t. Tax Declaration
V. Updated Real Property Tax Receipt
B. In
case the applicant is part of the National Housing Authority Projects
Original copy of the Notice of Award/Certification
1. Technical Description of lot from NHA
4. FVE (5)sets of plans (DULY SIGNED AND SEALED BY ARCH./ENGR.AND MUST ABIDE BY THE
NATIONAL BUILDING CODE OF THE PHILIPPINES; LIKE SETBACKS).
Complete Architectural Plan
Complete Structural Plan
Complete Electrical Plan
Complete Plumbing/ Sanitary Plan
Complete Electronics Plan (if applicable)
Complete Mechanical Plan (if applicable)
5. FIVE (5)sets of billofmaterials (SIGNED AND SEALED ON EVERY PAGE BY ARCH./ENGR.
CONCERN AND SIGNED BY THE OWNER EVERY PAGE).
6. FIVE (5)setsof specifications (SiGNED AND SEALED ON EVERY PAGE BY ARCH./ENGR.
CONCERN AND SIGNED BY THE OWNER EVERY PAGE),
7. Lot plan in 5 Blueprint Copies (SIGNED AND SEALED ON EVERY PAGE BY GEODETIC ENGR.)
8. Electrical Design Analysis, ShortCircuit Calculation, Voltage Drops Calculation in S sets
(SIGNED AND SEALED BY THE LICENSED PROFESSIONAL ELECTRICAL ENGINEER
9. Specimen signature,xerox copy of PRC I.D. and PTR of Engr./Arch. Concern.
10. Brgy. Clearance (forBuilding Permit/ Building Construction)
11. Latest Community Tax Certificate (Sedula) Photocopy
B. CITY PLANNING& DEVELOPMENT OFFICE
1. Location & Zoning Clearance and Official Receipt
C. BUREAU OF FIRE OFFICE
1. Fire Code Clearance, Fire Evaluation and official Receipt (FSEC}
FOR TWO STOREY LEVEL BLDG. & ABOVE
Structural Design Analysis 5sets/copies (SIGNED AND SEALED BY THE LICENSED
PROFESSIONAL CIVIL ENGINEER OR STRÜCTURAL ENGINEER)
FOR THREE STOREY LEVEL BLDG. &ABOVE(AS REQUIRED ON NBC AND NScP)
Soil Tests/Geotechnical Observation Analysis/ Sound Analysis
Boring / Load Tests Duly Signed and Sealed
FOR FOUR STOREY LEVEL BLDG. & ABOVE (AS REQUIRED ON NBC AND NsCP)
Earthquake Analysis

Assessed by Conform by:

Applicant /Owner
Date:
 JOSE
REPUBLIC OF THE PHILIPPINES

A
AT'S LAFTISILAMIIHA, 39DE,
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE *****7

AN
$an Jose del Monte, Bolacan
OFFICE OF THE CITY BUILDING OFFICIAL
AREA CODE 1420R
APPLICATION NO EUILDINGPERMITNO.

BUILDING PERMIT
DATE OF APPLICATION DATE ISSUED
ORIGINAL RENEWAL
BOX 1(TO BE ACCOMPLIGHED BYDESIGNINGARCHITECTGIVIL
LASTNAME
ENGHNEERIN PRIN)
FIRSTNAME M.I. TIN NO.
OWNER
FORM OWNERSHIF MAIN ECONOMIC ACTIVITY OF BUSINESSS

BY AN ENTERPRISE
TEL NO.
ADDRES5S
LOCATION OF CONSTRUCTION

NEW CONSTRUCTION OTHERS (SPECIFY)

SCOPE OF wORK
OF
ADDITON OF
REPAJR OF OF
RENOVATION OF
DEMOLITION OF NUMBER OF UNITS

OF OCCUPANCY
USE OR TYPE
RESIDENTIAL NDUSTTIAL
11 SINGLE 31 FACTORYPLANT
32 REPAIR SHOP/MA(HINE SHOP
12 DUPLE
33 REPINERY
ROWHOUSE/ACCESORIA
14 OTHERS (SPECIFY) 34 PRINTING PRES
35 WAREHOUSE
36 OTHERS(SPECIFY)-
COMMERCIAL
21 BANK STITUTIONAL
41 SCHOOL
STORE CHURCH ND OTHER RELIGIOUS STRUCTURES
42
23 HOTEL/MOTEL ETC.
OFFICE CONDOMNIUMBUSINESS OFFICE BUILOING HOSPITAL OR SIMILAR STRUCTURE

WELFARF: AND CHARITABLE STRUCTURE

RESTAURANT, ETO.
SHOP (e.g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC) THEATER, AUDITORIUM. GYMNASIUM, COURT

GASOLINE STATION OTHERS (SPECIFY)

MARKET

DORMITORY OR OTHER LODGING HOUSE AGRICULTURAL

230 OTHERS (SPECIFY)
51 BARN(S), PoULTRY HCUSE(S), ETOC.
2 GRAIN ILL
OTHER CONSTRUCTiON

OTHERS (SPECIFY) 50 OTHES (SPECIFY) .

60
LANDSCAPING & SIGNBORADS
STREET FURNITURE,
PARKS, PLAZAS, MONUMENTS, PoOLS, PLANT BOXES, ETO.

LAMPOSTS, ELECTRI POLES, TEL EPHONE ROLES, ETC

PROMENADES, TERRACES,
SIDEWALKS,
OUTDOOR ADS, SIGNBOARDS, ETC.

FENCEENCLOSURE
BOX 2 (TO BE ACCOMPLISHEDBY THE RECEIVING & RECORDING SECTION)
BUILDING DOCUMENTS(FIVE ETS EACH)
SITE DEVELOPMENTAND LOCATION PLAN MECHANI CAL PLANS & SPECIFICATIONS

ARCHITECHTURAL PLAN & SPECIFICATIONS LOGBOO: (1COPY)

STRUCTURAL DESIGN& COMPUTATIONS OTHERS (SPECIFY)
SANITARY/PLUMBING PLANS& SPECIFICATIÓNS

ELECTRICAL PLANS AND SPECIFICATIONS

BE ACcOMPLISHED BY THE BUILDING OFFICIAL)
BOX 3 (TO
ACTION TAKEN:
cONDITIONS:
PERMIT IS HERBY GRANTED SUSJECT TO THE FOLLOWING
CONSTRUCTION'ADDITION/REPAIR/RENOVATiON/DEMO.ITION

THATTHE PROPOSED GONFORMITY WITH THE NATIONAL BUILDING cODE

INSTALLATION ETC. SHALL BE IN
AND REGULATIO NS ARCH. PAVEL D. HALoG
AND ITS CORRESPONDING IMPLEMENTING RULES
(P.D. 1096) ARCHITECTICIVL ENGINEER HAS BEEN ENGAGED
TC
2 THAT A DULY LICENSED BUILOING OFFICIAL
THE SUPERVisI:NI
SPEGIFIGATIONS AND TO UNDERTAKE
PREPARE PLANS AND
OF THE PROJECT.
INSPECTION OF THE CONSTRUGTION
COMPLETION DULY SlGNED AND SEALED BY
THE IGNING DE
3 THAT A CERTIFICATE OF OF CONST RUCTION DATE
THE ARCHITECT/ENGINEER INOHARGE
ARCHITECT/ENGINEER AND
LATER THAN SEVEN DAYS AFTER COMPLETION OF THE
(7)
SHALL 13E SUBMITTED NOT
CONSTRUCTION OF THE PROJECT
SHALL BE SECURED PRIOR TO ACTU.IL OCCUPANCY
4 THAT A "CERTIFICATE OF OCCUPANCY
OF THE 3ULDING

NOTE: THIS PERMIT MAY CANGELLED OR REVOKE PURSUANT TOSETIONS

306& 306 OF THE NATIONAL BUILDINO GODE
Statistics Office, Building Official Fire Departrnent
one each for: applicant (original).As:sessor, National
To be accomplished in fve coples,
BOX 3A (TO BE ACcOMPLISHED BY DE8iONINO ARCHITECTICIVIL
TOTAL ESTIMATED CoST coST OF
ENOINEER INPRINT) DO NOTFILL (NOO USE ONLY)
BUILDING
NUMBER OF STOREYS
EQUIPMEN TOTAL FLaOR AREA
ELECTRICAL INSTALLEd PROPOSED DATE
MECHANICAL OF CONSTRUCTION
PLUMBING EXPECTED DATE
OTHERS OF COMPLETION.

MATERIAL OF CONST
TOTAL COST
DOX 4 (TO BE AGGOMPEISHED DY THE DIVISIONSECTION(WOOD CONC STEELMIXED)
CONCERNED)
ASSESSED FEES
AMOUNT AsSESSED BY.R. NUMBER DATE PAID

LINE and GRADE

BULDING
PLOMBING
ELECTRICAL
MECHANICAL

OTHERS REVISED
TOTAL CHIEF, PROCESSING DIVIDION/SECTION
BOX 5(TO BE ACCOMPLBNER BY THE DIVISIONSECTION GONCERNED)
PROGRESs FLOW

NOTED: N OUT ACTION/REMARKS PROCESSED BY

CHIEF, PROcESSING DIVISION/SECTION TIME DATE TIMEDATE

RECEIVING and RECORDING
LAND USE and ZONIN
GEODETIC (LINE and GRADE)
ARCHITECTURAL
STRUCTURAL

SANITARY
ELECTRICAL
MECHANICAL
wE HEREBY AFFIX OUR HAN0s IONIFYING OUR cONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX6 BOX8
ARCHITECTURALCIVIL ENGINEER PRC REG. NGSIGNATURE
SIGNED AND SEALED PLANS &SPECIFICATIONS
PRINT NAME
APPLICANT
ADDRESS COMMUNITY TAX CERT DATE ISSUED PLACE ISSUED

PTR DATE ISSUE PLACE ISSUED

SIGNATURE TIN
WITH MY CONSENT:
BOX7 BOX 9 (TO BE ACCOMPLISHED BY LOT OWNER)
ARCHITECTURALCIVIL ENGINEER PRCREG. NOTCTIOCT NO.
IN-CHARGE OFCONSTRUCTION
PRINT NAME PRINT NAME OF LOT OWNER

ADORESS ADDRESS
PTR DATE ISSUED PLACE ISSUED cOMMUNITY TAX CERTDATE ISSUED PLACE ISSUED

SIGNATURE TIN SIGNATURE TIN

 GSAN
REPUBLIC OF THE PHILIPPINES
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE
San Jose Del Monte,8ulacan
OFFICE OF THE CITY BUILDING OFFICIAL
AREA CODE 1420R
APPLICATION NO ESUILDING PERMIT NO.

BUILDING PERMIT
DATE OF APPLICATiON DATE ISSUED
ORIGINAL REMEWAL
BOX1( TO BE ACCOMPLISHEDBY DESIONING ARCHITECT/CIVIL ENGINEERIN PRINT)
OWNER LAST NAME FIRST NAME M.. TIN NO.

FORM OWNERSHIF MAIN ECONOMIÇ ACTIVITY OF BUSINESS

BY AN ENTERPRISE

ADDRESS TEL NO.

LOCATION OF CONSTRUCTION

SCOPE OFWORK 1NEW CONSTRUCTION OTHERS (SPECIFY)

ADDITION OF OF

3 REPAJR OF OF
RENOVATION OF
DEMOLITION OF NUMBER OF UNITS.

OR TYPE OF OccUPANCY
UsE
RESIDENTIAL NDUSTRIAL
11 SINGLE 31 FACTORY/PLANT
12 DUPLEX 32 REPAIR SHOP/MACHINE SHOP
33 REFINERRY
13 ROWHOUSE/ACCESORIA
OTHERS (SPECIFY) 34 PRINTING PRES
35 WAREHOUSE
36 OTHERS (SPECIFY)
COMMIERCIAL
INSTITUTmONAL
BANK
22 STORE SCHOOL
HOTELMOTEL ETC. 42 CHURCH NO OTHER RELIGIOUS STRUCTURES
OFFICE cONDOMINIUMABUSINESS OFFICE BUILDING HoSPITAL OR SIMILAR STRUCTURE

RESTAURANT, ETC. WELFARF: AND CHARITABLE STRUCTURE

SHOP (g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC) 45 THEATER, AUDITORIUM, GYMNASIUM, COURT

GASOLINE STATION 46 OTHERS (SPECIFY)

28 MARKET
DORMTORY OR OTHER LODgING HOUSE AGRICULTURAL
230 oTHERS(SPECIFY) 51 ARN(S), POLULTRY HOUSE(S), ETC.
OTHER CONSTRUCTION 52 LGRAIN AILL.
60 OTHERS (SPECIFY) 50 OTHERS (SPECIFY)

STREET FURNITURE, LAND8CAPING& SIGNBORADS

PARKS, PLAZAS, MONUMENTS, POOLS, PLANT 8OXES, ETC.
SIDEWALKS, PROMNADES, TERRACES, LAMPOSTS, ELECTRIC POLES, TEL EPHONE ROLES, ETC.

oUTDOOR ADS, SICNBOARDS, ETC

FENCE ENCLOSURE
BOX 2 (TO BE ACCOMPLIsHED BY THE RECEIVING &RECORDING SECTION)
BUILDING DOCUMENTs (FIVEETS EACH)
SITE DEVELOPMENT AND LOCATION PLAN MECHANI'CAL PLANs & SPECIFICATIONS
ARCHITECHTURAL PLAN& SPECIFICATIONS oGBOO (1cOPY)
STRUCTURAL DESIGN & COMPUTATIONS OTHERS (SPECIFY)
SANITARYIPLUMBING PLANS & SPECIFICATIONS

ELECTRICAL PLANSTHE
AND SPECIFICATIONS
BE ACCOMPLISHED BY BUILDING OFFICIAL)
80X 3 (TO
ACTION TAKEN:
PERMIT Is HEREBY GRANTED BUBJEOT TO THE FOLLOWING CONDITIONS:

1 THAT THE PROPO8ED CONSTRUCTIONADDITION/REPAIRIRENOVATION/DEMOL.ITION

INSTALL4TION ETC. SHALL BE IN CONFORMITY WITH THE NATIONAL BUILDING cODE

IMPLEMENTING RULES AND REGULATIO NS ARCH. PAVEL D. HALOG

(P.D. 109EI) AND ITS CORRESPONDING
2 THAT A DULY LICENSED ARCHITECTICiVL ENGINEER HAS BEEN ENGAGED TC)
PREPARE PLANS AND SPEÇIFICATIONS AND TO UNDERTAKE THE SUPERViSKKNI BUILDING OFFICIAL
INSPECTION OF THE CONSTRUCTION OF.THE PROJECT.
3 THAT A CERTIFICATE OF COMPLETION DULY SIGNED AND SEALED BY THE DEIGNING
ARCHITECT/ENGINEER AND THE ARCHITECT/ENGNEER INCHARGE OF CONST RUCTION DATE
SHALL 19E SUBMITTED NOT LATER THAN SEVEN () DAYS AFTER COMPLETION OF THE
CONSTRUCTION OF THE PROJECT
4 THAT A"CERTIFICATE OF OCCUPANO SHALL BE SECURED PRIOR TO ACTuL OGCUPANCY
OF THE 3UILDING

NOTE: TH1S PERMIT MAY CANGELLED OR REVOKE PURSUANT TO SECTIONS 305 4 306 OF THE NATIiÓNAL BUILDING CODE
To be accoimplished in five copies, one each for: applicant (original) Asrsessor, Nationel Statistics Ofice, Building Oficial Fire Department
BOX3A (TO BE ACCOMPLI9HED 9Y DES1GNINO ARCHITECT/GIVIL ENGINEER INPRINT) DO NOTFILL(NOQ USE ONLY)
TOTAL ESTIMATED CoST COSTOF
NUMBER OF STOREYS5.
BUILDING P EQUIPMEN TOTAL FLoOR AREA.
ELECTRICAL INSTALLEH PROPOSED DATE
MECHANICAL OF CONSTRUCTION
PLUMBINGG EXPECTED DATE
OTHERS OF COMPLETION

MATERIAL OF CONST.
TOTAL COST P (WOOD,cONC STEEL,MIXED).
BOX4 (TO BE AGCOMPESHED BY THE DIVISIONISECTION CONGERNED)
ASSESSED FEES
AMOUNT ASSESSED BY0.R. NUMBERL DATE PAID

LINE and GRADE

BULDING
PLUMBING
ELECTRICAL
MECHANICA

OTHERS REVISED
TOTAL |CHEF, PROCESSING DIVIDION/SECTION
BOK 5(TOBE ACCOMPLaMED BY THE DIVISIONSECTION CONCERNED)L
PROGRESS FLOW

IN UT ACTION/REMARKS PROCESSED BY
NOTED:
CHIEF, PROCESSINGDVISION/SECTION DATE TIME DATE

RECEVING and RECORDING

LAND USE and ZONING
GEODETIC (LINE and GRADE)
ARCHITECTURAL
STRUCTURAL

SANITARY
ELECTRICAL
MECHANICAL
WE HEREBY APFIX OUR HANDS SIaNIPYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE $ETFORTH

BOX BOX8
ARCHITECTURAL/CIVIL ENGINEER PRCREG. NdsIGNATURE
SIGNED AND SEALED PLANS& SPECIFICATIONS
PRINT NAME
APPLICANT
ADDRESS cOMMUNITY TAX CERT DATE ISSUED PLACE ISsUED

PTR DATE ISSUED PLACE ISsUED

-

SIGNATURE TIN
wITH MY CONSENT:

BOX7 BOX9(TO BE ACCOMPLISHED BY LOT OWNER

ARCHITECTURALUCIVIL ENGINEER PRC REG. NGTCT/OCT NO.
IN-CHARGE OF CONSTRUCTION PRINT NAME OF LOT OWNER
PRINT NAME
ADORESS ADDRESS
DATE ISSUED PLACE ISSUED COMMUNITY TAX CERT DATE IssUED PLACE ISSUED
PTR
SIGNATURE TIN SIGNATURE TIN
 N GS A
OSE D REPUBLIC OF THE PHILIPPINES
PROVINGE OFBULACAN
CITY OF SAN JO3E DEL MONTE
San Jose bel Monte,guiacan

OFFICE OF THE CITY BUILDING OFFICIAL

AREA CODE 1420R
APPLICATION NO_ UILDING PERMITNO.

BUILDING PERMIT
DATE OF APPLICATION DATE ISSUED

ORIGINAL REMEWAL

BOX 1(TOBE AÇCOMPLISHED BY DESIONING ARCHITECT/GIVILENGINEER IN PRINTM.

oWNER LAST NAMEE FIRSTNAME TIN NO.

FORM OWNERSHIF MAIN ECONOMIC ACTIVITY OF BUSINESS

BY AN ENTERPRISE

ADDRESS TEL NO.

LOCATION OF CONSTRUCTION
SCOPEOF wORK NEWCONSTRUCTION OTHERS (SPECIFY)
ADDImION OF OF.

REPAIROF OF
RENOVATION OF.
DEMOLITION OF NUMBER OF UNITS

USE OR TYPE OF OcCUPANCY

RESIDENTIAL INDUSTRIAL
1 SINGLE 31 FACTORY/PLANT
32 REPAIR SHOP/MACHINE SHOP
2 DUPLEX
33 REFINERY
ROWHOUSE/ACCESORIA
OTHERS (SPECIFY) PRINTING PRESS
35 WAREHOUSE
36 OTHERS (SPECIFY)
cOMMERCIAL
1 BANK INSTITUTiONAL
41 SCHOOL
STORE
42 CHURCH NO OTHER RELIGIOUS STRUCTURES
HOTELAMOTEL ETC.
OFFICE CONDOMINIUMBUSINESS OFFICE BUILOING HOSPITAL OR SÍMILAR STRUCTURE

RESTAURANT, ETO. 44 WELFARF: AND CHARITABLE STRUCTURE

SHOP (e.g. DRESS SHOP, TAILORING SHOP, SARBER SHOP, ETC) 45 THEATER, AUDITORIUM, GYMNASIUM, COURT

GASOLINE STATION 46 OTHERS (SPECIFY)

28 MARKET
DORMITORY OR OTHER LODGING HOUSE AGRICULTURAL
OTHERS (SPECIFY) 51 BARN(S), POULTRY HCUSE(S), ETC.
30
OTHER CONSTRUCTiON 52 GRAIN AILL
OTHERS (SPECIFY 50 OTHES (SPECIFY)
80
STREET FURNITURE, LANDSCAPING&SiGNBORADS

PARKS, PLAZAS, MONUMENTS, POOLS, PLANT 80XES, ETC.

71
sI0EWALKS, PROMENADEs, TERRACES, LAMPOSTS. ELECTRIC POLES, TEL EPHONE ROLES, ETC
OUTDOOR AD6, SIGNBOARDS, ETC.

FENCE ENCL0SURE
BOX 2 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)

BUILDING DOCUMENTS(FIVEETSEACH)
SITE DEVELOPMENTAND LOCATION PLAN MECHANICAL PLANS & SPECIFICATIONS
ARCHITECHTURAL PLAN& SPECIFICATIONS LOGBOOR (1COPY)
STRUCTURAL DESIGN& COMPUTATIONS OTHERS ( SPECIFY)
SANITARYIPLUMBING PLANS& SPECIFICATIÓNS

ELECTRICAL PLANS AND SPECIFICATIONS

(TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
BOX 3
ACTION TAKEN:
THE FOLLÓWING CONDITIONS:
PERMIT IS HEREBY GRANTED 8UBJECT TO
1 THAT THE PROPoSED CONSTRUCTIONADDITION/REPAIR/RENOVATION/DEMOL.iriON
WITH THE NATIONAL BUILDING cODE
INSTALLATION ETC. SHALL BE IN CONFORMITY
AND REQULATIO NS ARCH. PAVEL D. HALOG
ITS CORRESPONDING IMPLEMENTING RULE8
(P.D. 108) AND ARCHITECTICIVIL ENGINEER HAS BEEN ENGAGED TC
2 THAT A DULY LICENSED
TO UNDERTAKE THE SUPERVISIINI BULOING OFFICIA
PREPARE PLANS AND SPEÇIFICATIONS AND
INSPECTiON OF THE CONBTRUCTION OF THE PROJECT
DULY SIGNED AND SEALED BY THE DEIIGNING
3 THAT A CERTIFICATE OF COMPLETION -
ARCHTECT/ENGINEER INOHARGE OF CONST RUCTION DATE
ARCHITECT/ENGINEER AND THE
THAN SEVEN (7) DAYS AFTER COMPLETION OF THE
SHALL 1BE SUBMITTED NOT LATER
CONSTRUOTION OF THE PROJECT.
SHALL BE SECURED PRIOR TO ACTU. AL OCCUPANCY
4 THAT A "CERTIFICATE OF OCCUPANCY
OF THE 3UILDING

NOTE: THIS PERMIT MAY GANGELLED OR REVOKE PURSUANT TOSECT ONS 308 4 306 OF THE NATIONAL BUILOINGcODE
To be accoImplished in five copies, one eaoh for: applicant (original). As:iessor, Netional Statistics Offioe, Building Oficial Fire Departnient
BOX 3A (TO BE AGcOMPLISHED BY DEoIONING ARCHITEGTICIVIL EN9INEER IN PRINT) DO NOTFILL(N8O USEONLY
TOTAL ESTIMATED COST cOST OF NUMBER OF STOREYS
BUILDING EQUIPMEN TOTAL FLOOR AREA,
ELECTRICAL INSTALLED PROPOSED DATE
MECHANICAL OF CONSTRUCTIO
PLUMBING EXPECTED DATE
OTHERS OF COMPLETION,

MATERIAL OF CONST
TOTAL COST P (WOOD,CONG STEEL,MIKED)
BOX 4 (TO BE ACCOMPEISHED DY THE DIVISIJONISECTION CONGERNED)
ASSESSED FEES
AMOUNT ASSESSED BY0.R. NUMBER DATE PAID

LINE and GRADE

BUILDING
PLOMBING
ELECTRICALL
MECHANICAL

OTHERS REVISED
TOTAL JCHIEF, PROCESSING DIVIDION/SECTION
BOX(TO BE ACCOMPLISHER EY THE DIVISIONSECTION CONCERNED)
PROGRESS FLOW

NOTED: IN OUT ACTION/REMARKS PROCESSED BY

CHIEF, PROCESSINGDIVISION/SECTION TIME DATE TIME DATE

RECEIVING and RECORDING
LAND USEend ZONING
GEODETIC (LINE and GRADE)
ARCHITECTURAL
STRUCTURAL
SANITARY

ELECTRICAL
MECHANICAL
we HEREBY AFFIXoUR HANos 8IONIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABoVE SETFORTH

BOX6 BOX8
ARCHITECTURALCIVIL ENGINEER PRCREG. NdSIGNATURE
SIGNED AND SEALED PLANS &SPECIFICATIONS
PRINT NAME
APPLICANT
COMMUNITY TAX CERT DATE IssUED PLACE ISSUED
ADDRESS
PTR DATE ISSUED PLACE ISSUED
SIGNATURE

WITH MY cONSENT:
BOX7 BOX (TO BE AGGOMPLISHED BY LOT OWNER
PRC REG. NOTCT/OCT NO.
ARCHITECTURALCIVIL ENGINEER
IN-CHARGEOF CONSTRUCTION PRINT NAME OF LOT OWNER
PRINT NAME

ADORESSS ADDRESS

PTR DATE ISSUED PLACE ISSUED COMMUNITY TAX CERT|DATE ISSUED PLACE ISSUED
SIGNATURE TIN SIGNATURE TIN
 .

ANO OSE D REPUBLIC OF THE PHILIPPINES

PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE
$a0 Jose del Momte,8olacan
UTAK
OFFICE OF THE CITY BUILDING OFFICIAL
AREA CODE 1420R
APPLUCATIQNNO FSUILDING PERMITNO.

BUIL.DING PERMIT
DATE OF APPLICATION DATE ISSUED

RENEWAL
ORIGINAL
BOX1 (TO BE AÇCOMPLISHED BY DESIONING ARCHITECT/CIVIL ENGINEER IN PRINT)
LAST
NAME FIRST NAME M.. TIN NO.
OWNER
FORM OWNERSHIF MAIN ECONOMIÇ ACTIVITY OF BUSINESS

eY AN ENTERPRISE
.

TEL NO.
ADDRESSs
.LOCATION OF CONSTRUCTION

SCOPE OF WORK 1 NEWCoNSTRUCTION. OTHERS (SPECIFY)

ADDITON OF OF

3 REPAUR OF
RENOVATION OF
DEMOLITION OF NUMBER OF UNITS

OccUPANCY
USE OR TYPE OF
RESIDENTIAL INDUSTRIAL
11 SINGLE 31 FACTORYIPLANT

H
DUPLEX 32 REPAIR SHOPMA(HINE SHOP
12
33 REFINERYY
13 ROWHOUSE/ACCESORIA
OTHERS (SPECIFY 34 PRINTINGPRESS
35 WAREHOUSE
36 OTHERS(SPECIFY)
cOMMERCIAL
21 BANK INSTITUTIONAL
41 sCHOOL
22 STORE
42 CHURCHAND OTHER RELIGIOUS STRUCTURES
HOTELMOTEL ETC.
OFFICE cONDOMINIUMBUSINESS OFFICE BUILDING HoSPITAL OR SIMILAR STRUCTURE

44 WELFARF: AND CHARITABLE STRUCTURE

25 RESTAURANT, ETC.
SHOP (eg. DRESS SHOP, TAILORING SHOP, SARBER SHOP, ETC) 45 THEATER, AUDITORIUM, GYMNASIUM, COURT
2
GASOLINE STATION OTHERS (SPECIF)
28 MARKET
DORMITORY OR OTHER LODGING HOUSE AGRICULTURAL
OTHERS (SPECIFY)
51 BARN(S), POLuLTRY HOUSE(S). ETC.
30
OTHER CONSTRUCTION 52 GRAIN MAILL
60 OTHERS (SPECIFY) 50 oTHES (SPECIFY).
LANDBCAPING & SIGNBORADS
STREET FURNITURE,
PARKS, PLAZAS, MONUMENTS, PoOLS, PLANT 8OXES, ETC.
SIDEWALKS, PROMENADES, TERRACES, LAMPOSTS, ELECTRIC POLES, TEL EPHONE ROLES, ETC.

oUTDOOR ADs, SIGNBOARDS, ETC.

FENCE ENCLOSURE
& RECORDING SECTION)
BOX 2 (TO BE ACCOMPLISHED BY THE RECEIVING - - -

BUILDING DOCUMENTS (FIVE ETSEACH)

MECHANICAL PLANS & SPECIFICATIONS
SITE DEVELOPMENT AND LOCATION PLAN
ARCHITECHTURAL PLAN& SPECIFICATIONS LOGBOO (1COPY)
STRUCTURAL DESIGN&COMPUTATIONS OTHERS (SPECIFY)
SANITARYIPLUMBING PLANS & SPECIFICATIONS

ELECTRICAL PLANS AND SPECIFICATIONS

BOX 3 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTON TAKEN:
PERMIT IS HEREBY GRANTED BUBJECT TO THE FOLLÓWING CONDITIONS:
THAT THE PROPOSED CONSTRUGTICNADDITION/REPARRENOVATION/DEMOL.ITION
INSTALLATION ETG. BHALL BE IN GONFORMITY WITH THE NATIONAL BUILDING coDE

AND REGULATIO NS ARCH. PAVEL D. HALOG

(P.D. 1006) AND ITS CORRESPONDING IMPLEMENTING RULES
ENGINEER HAS BEEN ENGAGED TCI
2 THAT A DULY LICENSED ARCHITECT/GIVIL
PREPARE PLANS AND SPEÇIFICATIONS AND TO UNDERTAKE THE SUPERVISIONI BULOING OFFICIAL.
INSPECTION OF THE CONSTRUCTION OF THE PROJECT.
DULY SIdNED AND SEALED BY THE DEIGNING
3 THAT A CERTIFICATE OF COMPLETION INCHARGE OF CONST RUCTION DATE
ARCHITECT/ENGINEER AND THE ARCHTECT/ENGINEER
DAYS AFTER COMPLETION OF THE
NOT LATER THAN SEVEN (7)
SHALL 13E SUBMITTED
CONSTRUCTION OF THE PROJECT.
THAT A "CERTIFICATE OF OCCUPANCY SHALL BE SECURED PRIOR TO ACTU. AL OCCUPANCY
OF THE 13UILOING
NOTE: THIS PERMWT MAY CANGELLED OR REVoKE PURSUANT TO SECTIONS 305 J06 OF THE NATIONAL BUILcINO CODE

To be accomplished in fve copies, one each for: applicant (original).Asessor, National Statistics Office, Building Oficial Fire Departnient
BOX 3A (TO BE ACcOMPLISHED BY DEsIGNING ARGHITECT/GIVIL ENOINEER IN PRINT)
TOTAL ESTIMATED COST CoST OF
NUMBER OF STOREYS PO NOTFLL (NOO UBE ONLY)
BUILDINGG EQUIPMEN TOTAL FLOOR AREA
ELECTRICAL INSTALLE PROPOSED DATE
MECHANICAL OF CONSTRUCTION
PLUMBING EXPECTED DATE
OTHERS OF COMPLETION.

MATERIAL OF CONST
TOTALCOST P
BOX (TO BE AGCOMPEISHED Y THE DIVI1SIONSECTION(WOOD,CONG STEELMIXED)
CONCERNED)
ASSESSED FEES
AMOUNT ASSESSED BY .R. NUMBER DATE PAID

LINE and GRADE

BUILDING
PLOMBING
ELECTRICAL
MECHANICAL

OTHERS REVISED
TOTAL CHIEF, PROCESSINGDIVIDION/SECTION
BOX& (TO BE ACCOMPLSHED BY THE DIVISI9NSESTION CONCERNED)
PROGRESS FLOW

NOTED: N
OUT ACTION/REMARKS PROCESSED BY

CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIMEDATE

RECEVING and RECORDING
LAND USEand ZONING
GEODETIC (LINE and GRADE)
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
we HEREBY AFFIX oUR HANos 8iGNIFYING OUR cONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX 6 BOX8
ARCHITECTURALCIVIL ENGINEER PRC REG. NqsIGNATURE

SIGNED AND SEALED PLANS &SPECIFIGATIONS

PRINT NAME
APPLICANT
cOMMUNITY TAX CERT DATE ISSUED PLACE ISSUED
ADDRESS
PTR DATE ISSUED PLACE ISSUED
SIGNATURE TIN
WITH MY cONSENT:

BOX7 BOX (TO BEACCOMPLISHED BY LOT OWNERL

PRO REG. NTCTIOCT NO.
ARCHITECTURALCIVIL ENGINEER
IN-CHARGEOF CONSTRUCTION
PRINT NAME OF LOT OWNER
PRINT NAME
ADORESS ADDRESS

PTR DATE ISSUED PLACE ISSUED COMMUNITY TAX CERT DATE ISSUED PLACE ISSUED

SIGNATURE TIN SIGNATURE TIN

 KAN SO
REPUBLIc OF THE PHILIPPINES
PROVINGEOF BULACAN
CITY OF SAN JOSE DEL MONTE
AN
San Jost det Nonte,Bulacan
AK
OFFICE OF THE CITY BUILDING OFFICIAL
AREA CODE 1420R
APPLICATIONNO TAUILDING PERMITNO

BUILDING PERMIT
DATE OF APPLICATION DATE ISSUED
ORIOINAL RENEWAL
BOX 1( TO BE ACCOMPLuSHEDBY DESIONING ARCHITECTIGIVIL ENGINEERIN PRINT).
FIRST NAME M. TIN NO.
OWNER LAST NAME
ORM OWNERSHIF MAIN ECONOMIC ACTIVITY OF BUSINESS
BY AN ENTERPRISE
TELNO.
|ADDRI
RESS

LOCATION OF CONSTRUCTION
OTHERS (SPECIFY)
SCOPE OF WORK NEW CONSTRUCTION
OF
ADDITION OF
3 REPAJR OF OF
RENOVATION OF
5 DEMOLITION OF NUMBER OF UNITS

USE OR TYPE OF ocCUPANCY

RESIDENTIAL INDUSTRIAL
31 FACTORYIPLANT
SINGLE
32 REPAIR SHOP/MAHINE SHOP
DUPLEEX
33 REFINERY
13 ROWHOUSE/ACCESORIA
34 PRINTING PRES3
OTHERS (SPECIFY
35 WAREHOUSE

|COMMEECIAL
36 OTHERS
(SPECIFY) -
21 BANK INSTITUTiONAL
41 sCHOOL
22 STORE CHURCHAND OTHER RELIGIOUS STRUCTURES
23 HOTELMOTEL ETC.
OFFICE CONDOMINIUM/BUSINESS OFFICE BUILDING 43 HOSPITAL OR SIMILAR STRUCTURE
24
WELFARE: AND CHARITABLE STRUCTURE
RESTAURANT, ETC.
THEATER, AUDITORIUM, GYMNASIUM, COURT
SHOP, BARBER SHOP, ETC)
SHOP (g. DRESs SHOP, TAILORING
27 GASOLINE STATION OTHERS (SPECIFY-
MARKET
29 DORMITORY OR ÓTHER LoDGING HOUSE AGRICULTURAL
51 BARNS), POULTRY HOUSE(S). ETC
30 oTHERS (SPEIF)
52 GRAIN AILL
OTHER CONSTRUCTION

OTHERS (SPECIFY) 50 OTHE":S (SPECIFY)

60
LANDSCAPING & SIGNBORADS
STREET FURNITURE, ETC.
PARKS, PLAZAS, MONUMENTS, PoOLS, PLANT 8OXES,
ELECTRIC POLES, TEL EPHONE ROLES, ETC
SIDEWALKS, PROMENADES, TERRACEs, LAMPOSTS,
OUTDOOR ADS, SIGNBOARDS, ETC.
7
FENCE ENCLOSURE
BE ACCOMPLISHED BY THE RECEVING
& RECORDING SECTION)
BOX 2 (TO
BUILDING DOCUMENTS(FIVESETSEACH)
SITE DEVELOPMENT AND LOCATION PLAN MECHANICAL PLANS & SPECIFICATIONSs
ARCHITECHTURAL PLAN& SPECIFICATIONs LOGBOO: (1COPY)
STRUCTURAL DESIGN& COMPUTATIONS OTHERS ( SPECIFY)
SANITARYIPLUMBING PLANS& SPECIFICATIONS

ELECTRICAL PLANS AND SPECIFICATIONS - - -

ACCOMPLISHED BY THE BUILDING OFFICIAL)

(TO BE
BOX 3
ACTION TAKEN:
PERMIT IS HEREBY GRANTED
SUBJECT TO THE FOLLÓWING CONDITIONS
CONSTRUCTIONADDITION/REPAIRIRENOVATiON/DEMOL.ITION

1 THAT THE PROPOSED cODE

INSTALLATION ETC. SHALL BE IN GONFORMITY
WTH THE NATIONAL BUILDING
AND REGULATIO NS
ARCH. PAVEL D. HALOG
IMPLEMENTING RULES
(P.D. 1086) AND ITS CORRESPONDING ENGINEER HAS BEEN ENGAGED TC
2 THAT A DULY LICENSED ARCHITECTICIVIL SUPERVISI:NI BUILOING OFFICIA.
TO UNDERTAKE THE
PREPARE PLANS AND
SPEÇIFIGATIONS AND
CONSTRUCTION OF THE
PROJECT.
INSPECTION OF THE DEIGNING
DULY 8IGNED AND SEALED BY THE
- -

3 THAT A CERTIFICATE
OF GOMPLETION INCHARGE OF CONST RUCTION
DAT

ARCHITECT/ENGINEER AND THE ARGHTECT/ENGINEER

AFTER COMPLETION OF THE
LATER THAN SEVEN (7) DAYS
SHALL BE SUBMITTED NOT
CONSTRUCTION OF THE PROJECT.
SECURED PRIOR TO ACTU IL OCCUPANCY
OF OCcCUPANCY" SHALL BE
4 THAT A "CERTIFICATE
OF THE 3ULDING

PURSUANT TO SECTIONS 308 &306 OF THE NATIONAL

BUILDING cODE
NOTE: THIS PERMT MAY CANGELLED OR REVOKE Official Fire Department
To be accoImplished in five copies, one each for: applicant (original) As:iessor, Netional Statistics Office, 9uilding
BOX A (TO BE AGCOMPLISHEDBY DESiONINO ARGHITECT/GIvIL ENOINEERIN PRINT) DO NOTFILL(NOO USE ONLY)
TOTAL ESTIMATED coST coST OF NUMBER OF STOREYS
BUILDING P EQUIPMEN TOTAL FLoOR AREA
ELECTRICAL INSTALLEd PROPOsED DATE
MECHANICAL CONSTRUCTION
PLUMBINGG EXPECTED DATE
OTHERS OF COMPLETION,

MATERIAL OF CONST
TOTAL CoST P
(WOOD,CONC STEEL,MIXED)
BOX4 (TO BE ACCOMPLISHEDOY THE DIViSIONISECTION CONGERNED)
.

AS8ESSED FEES
AMOUNT AsSESSED BY9.R. NUMBER DATE PAID

LINE and GRADE

BUILDING
PLUMBING
ELECTRICAL
MECHANICAL
JLLLLL
OTHERS REVISED
TOTAL GHIEF, PROCESSING DIVIDION/SECTION
BOX &(TO BE ACCOMPLGHED BY THE DIVISIONSECTION CONCERNED)
PROGRESs FLOW

N
OUT ACTION/REMARKS PROCESSED BY
NOTED
CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIMEDATE
RECEIVING and RECORDING
LAND USE ndZONING
GEODETIC (LINEand GRADE)
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
we HEREBY APPIx OUR HANDS S1GNIFYING OUR cONFORMITY TO THE INFORMATION HEREIN ABoVE SETFORTH

BOXE BOX
8
ARCHITECTURALCIVIL ENGINEER PRCREG. NdSIGNATURE
SIGNED AND SEALED PLANS &SPECIFICATIONS
PRINT NAME
APPLICANT
cOMMUNITY TAX CERT DATE ISSUED PLACE ISsUED
ADDRESS

PTR DATE ISSUED TPLACE ISSUED

SIGNATURE TIN
WITH MY cONSENT:
BOX (TO BEACCOMPLIHED BYLOT OWNER)
BOX7 PRCREG. NQTCTIOCT NO
ARCHITECTURAUCIVIL ENGINEER
IN-CHARGE OF CONSTRUCTION PRINT NAME OFLOT OWNER
PRINT NAME

ADORESS ADDRESS
PTR DATE ISSUED PLACE ISSUED COMMUNITY TAX CERTDATEISSUED PLACE ISsUED

UN SIGNATURE TIN
SIGNATURE
 REPUBLIC OF THE PHILIPPINES
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
SIMPLE cOMPLEX
NEW RENEWAL AMENDATORY
THIS APPLIES FOR: LOCATIONAL CLEARANCE LFIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO AREANO
BOX1 ( TO BE ACCOMPLISHED BY DESIGNING ARCHITECTICIVIL ENGINEER N PRINT)
OWNER LAST NAME FIRST NAME TIN NO.
DO NOT FILL-UP (PSA USEN ONLY)
FOR CONSTRUCTION OWNED FORM OVWNERSHIP MaiN ECONOMIC ACTIVITY OFBUSINESS
BY AN ENTERPRISE

ADDRESS NO. STREET, BARANGAY CITYMUNICIFALITY ZIP CODE TEL NO

|LOCATION OF CONSTRUCTION: LOTN BLK. NO: TCTNO: CURRENT TAX DEC NO

STREET BARANGAY CITYMUNICIPALITY OF
SCOPE OFWORK
NEW CONSTRUCTION LRENOVATION RAISING
ERECTIONL cONVERSION ACCESsORY BUILDING/STRUCTURE
ADDITION REPAIR- LEGALZATION OF EXISTING BUILDING

ALTERATION MOVING JOTHERS (SPECIFY

USE OR TYPE OF
OCCUPANCY
GROUPA: RESIDENTIALDWELLINGS LRESIDENTIAL R-1.R-2 GROUPG: MEDIUMINDUSTRIAL
LSTORAGEWAREHOUSE (FOR HAZARDOUS
SINGLE DUPLEX HIGH FLAMMABLE MATERIALS
LJOER FACTCRY (FOR HAZARDOUS/HICHLY
GROUP B: RESIDENTIAL FLAMMABLE MATERA S

HOTEL MOTEL TOWNHOUSE LOTHERS

DORMITORY 80ARDDING HOUSE
RESIDENTIAL R-3 R4,R-5 LLODGING HOUSE
OTHERS LGROUP H: ASSEMBLY (OCCUPANT
LOAD LESS THAN 1,000)

GROUP C: EDUCATIONAL& RECREATIONAL LTHEATER AUDITORIUM CONVENTION HALL,

SCHOOL BUILDING SCHOOL AUDITORIUM. GRANDSTAND/ BLEACHER
CIviC CENTER CLUBHOUSE GYMNASIUM JOTHERS
OTHERS CHURCH AND
RELIGIOUs STRUCTURES
GROUP D: 1NSTITUTIONAL GROUP I: ASSEMBLY (OCCUPANT
HOSPITAL OR SIMILAR STRUCTURE LOAD 1,000 OR MORE)
HOME FOR AGED coLISEUM, SPORTS C M
GOVERNMENT OFFICE
OTHERS STRUCTURE
LJOTHERS
AR
cONVENTION CENTER AND SIMILAR
L
GROUP E: COMMERCIAL
BANK STORE
DRINKING/ DINING GROUP J: (J-1 AGRICULTURAL)
BARN(S), GRANARY, POLLTRY HOUSES)
ESTABLSHMENT PIGERRY,GRAIN MILL, GRAIN SILO
SHOP (e.g.ORESS SHOP, TALORING SHOP
ARE
N OOP, ETC.) LJOTHERS
P P I N G CENTER / MALL

OTHERS
ROUP ACESSURIES)
PRIVATE CARPORT/ GARAGE, TOWER.
OROUP F: LIGHT INDUSTRIAL
LFACTORYPLANT (USING INCOMBUSTIBLE/ SwIMMING POOL, FENCE OVER 1.80m
NON-EXPLOSIVE MATERIALS) STEEUCONCRETE TRANK

oTHERS LJOTHERS
OCCUPANCY CLASSIFIED TOTAL ESTIMATED COST:
NUMBNER OF UNITS BUILDING COST OF EOUIPMENT INSTALLED
NUMBER OF STOREY ELECTRICAL
TOTAL FLOOR AREA SQ.M. MECHANICAL
1.OT AREA sOM. ELECTRONICS
PLUMBING
PROPOSED DATE OF CONSTRUCTION ECXPECTED SATEOF COMPLETION
FULLTIMEINSOECTOR AND SUPERVISOR OF CONSTRUCTION WORKS(REPRESENTNG THE OWNER
AOORESS
ARCHITECT OR CIVIL ENGINEER PRCNO. VALIDITY
(SIGNED AND SEALED OVER PRINTED NAME) PTRNO |DATE ISSUED
DATE |iSSUED AT TIN
BOX BOX 4
APPLICANT: wITH MY CONSENT LOT ÓWNERTAUTHORI}ED REPRESENTATIVE
DATE DATE
(SIGNEDAND SEALED OvER PRINTED NAME) (SIGNED AND SEALED OVER PRINTED NAME)
ADDRESS ADDRESS
SOED ID N DATE I6SUED PLACE ISSUED GOVT. ISSUEDID NO DATESSUED PLACE ISSUEO
REPUBLIC OF THE PHILIPPINES S.S.

CITYMUNICIPALITY OF-
BEFORE ME. at the City/ Municlpalty of bersonally appeared the
following:
APPLICANT GOVT.N ISSUEDID NO DATE ISSUED PLACE ISSUED

LICENSED ARCHITECT OR CIVIL ENGNEER GOVT.N ISSUEDID NO DATE ISSUED PLACE ISSUED
(FuIAme Inspector and Suparisor of Construcion Works)

whose signatures appear herinebove, known to me the same person who execute1 this standard prescribed fom and acknowiedged to me that the same is their frea anc
vofuntary act and deed.

WITNESS MY HAND AND SEAL on the date and place above written.
Doc No:
Page No
Book No NOTARY PUBLIC
Series o
 EVALUATION DIVISION)
BOX6 ( TO ACCOMPLISHED BY THE PROCESSINGAND
BASIS OF AMOUNT ASSEESSED BY
ASSESSED FEES DATE
ASSESSMENT
FOR ZONNING ( ZONING ADMINISTRATOR:
|LOCATIONAL/ZONING OF LAND
FOR FIRE SAFETY (BFP):
FIRE CODE CONSTRUCTION TAX

HOTWORKS
FOR BUILDINGI STRUCTRE
(OBO):
FILLING FEE

LINE ANDGRADE
FENCNG
ARCHITECTURAL

CVIL/STRUCTURAL
ELECTRICAL
MECHANICAL

SANITARY

PLSING
ELECTRONICS
INTERIOR
EXCAVATION
SIGNAGE
r
PENALTIES
SURCHARGE

OTHERS: ANCILLARY

TOTAL:
TERMS ANDCONDITIONS:

1. The Owner/Applicant shall Accomplish the Prescribe Application Form, with the
assistance of the concerned design professional/s or Architect/Civil Engineer,
the

hired/commissioned by him/her as full-time inspector/supervisor ofthe construction

works, by filling up the necessary data / information required thereat.

Thave read this form, understood its contents and consent thethe
to processing
of my personal data. I understand that my consent does not preclude
and does not
existence ofother criteria for lawful processing of personal data,other
any of my rights under the Data Privacy
Act of 2012 and applicable
waive
laws.

Owner Applicant
(Signature Over Printed Name)
 REPUBLIC OF THE PHILIPPINES
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
sIMPLE COMPLEX
NEW RENEWAL AMENDATORY
THIS APPLIES FOR: ULOCATIONAL CLEARANCE LFIRE SAFETY EVALUATION CLEARANCE
APPLICATIQN NO AREA NO
BOX1(TO
OWNER
BE ACCOMPLISHED BYDESIGNING ARCHITECT/CIVIL. ENGINEER NPRINT)
LAST NAME FIRST NAME TIN NO.
DO NOT FILL-UP (PSA USEN ONLY
FOR CONSTRUCTION OWNED FORM OWNERSHIPP MAIN ECONOMIC ACTIVITY OF BUSINESS
BY AN ENTERPRISEE

ADDRES. NO. STREET, BARANGAY. OTV

CITYIMUNICIFAL!TY ZIP CODE TEL NO JL
LOCATION OF CONSTRUCTION. LOT NO: BLK. NO TCT VO. CURRENT TAX DEC NO:
TREET BARANGAY CITYMUNIC!PALITY OF,
SCOPE OF WORK
NEW CONSTRUCTION ENOVATION RAISING
ACCESSORY BUILDING/STRUCTURE
ERECTION jcONVERSIiON
ADOITION. }REPAIR LEGALIZATION OF EXISTING BUILDING
JALTERATION MOVING jOTHERS (SPECIFY)
USE OR TYPE OF OCcUPANCY
GROUP A: RESIDENTIAL(DWELLINGS GROUP G: MEDIUM INDUSTRIAL
SINGLE DUPLEX CRESIDENTIAL R-1,R-2 ]STORAGEWAREHOUSE (FOR HAZARDOUS/
OTHERS HIGH FLAMMABLE MATERIALS
FACTCRY (FOR HAZARDOUS/HICHLY
GROUP B: RESIDENTIAL FLAMMABLE MATERIA S

HOTEL MOTEE TOWNHOUSE OTHERS

DORMITORY BOARDDING HOUSE,
RESIDENTIAL R-3 R4R-5 DGIN HOUSE

LOTHERS GROUP H: ASSEMBLY (OCCUPANT

LOAD LESS THAN 1,000)
GROUP C: EDUCATIONAL & RECREATIONAL LTHEATER, AUDITORIUM CONVENTION HALL
sCHOOL BUILDING SCHOOL AUDITORIUM. GRANDSTAND/ BLEACHER
CIvic CENTER CLUBHOUSE jGYMNASIUM jOTHERS
JoTHERS JCHURCH AND
RELIGIOUS STRUCTURES
GROUP D: INSTITUTIONAL
HOSPITAL OR SIMILAR STRUCTURE
GROUP:ASSEMBLY toccuPANT
LOAD 1,00 OR MORE)
HOME FOR AGED JcoLISEUM, SPORTS COMPLEX
GOVERNMENT OFFICE CONVENTION CENTER ANO SIMILAR
LOTHERRS STRUCTURE
LJOTHERS.
GROUP E: COMMERCIAL
BANK STORE
JORINKINGI DINING GROUP J: (J-1 AGRICULTURAL)
ESTABLISHMENT BARN{S), GRANARY, POULTRY HOUSES)
LSHOP(eg ORESS SHOP, TALORING SHOP, _PIGERRY,GRAIN MILL, GRAIN SILO
BARBER SHOP, ETC.) OTHERS
SHOPPING CENTERI MALL
OTHERS_
oROUP F: LIGHT INOUSTRIAL
GROUP J: (J-2 ACCESSORIES
PRIVATE CARPORT/ GARAGE, TOWER,
LFACTORYPLANT (USING INCOMBUSTIBLE SwIMMING POOL, FENCE OVER 1.80m
NON-EXPLOSIVE MATERIALS) STEEUCONCRETE TRANK
LOTHERS LOTHERS
OccUPANCY CLASSIFIED TOTAL ESTIMATED COST:
NUMBNER OF UNITS BUILDING COST OF EOUIPMENT INSTALLED
NUMBER OF STOREY ELECTRICAL
TOTAL FL0OR ARE SQ.M MECHANICAL
AREA Sa.M ELECTRONICS
PLUMBING
PROPOSED DATE OFCONSTRUCTION ECXPECTED BATE OFCOMPLETON
BOX 2
FUL TIMEINSECTORANDSUFERVISOROFCONSTRUCTON WORKES(REPRESENTINGTHEOWNE ADORESS
ARCHITECT ORCIVIL ENGINEER
(SIGNED ANO SEALEO OVER PRINTED NAME)
PRO NO. VALIOIT
PTR NO. DATE ISSUED
DATE:. ISSUED AT ITIN
BOX
JAPPLICANT
BOX 4
WITH MY CONSENT LOTOWNERIAUTHORIZED REPRESENTATIVE
DA1E DATE
(SIGNEDAND SEALED OVER PRINTED NAME) (SIGNED AND SEALED OVER PRINTED NAME)

ADDRESS ADDRESS
ISSUED 1D NO DATE ISSUED IPLACE ISSUED GOVT. ISSUEDID NO DATEISSUED PLACE ISSUEO
REPUBLIC OF THE PHILIPPINES S.S
CITYMUNICIPALITY OF
BEFORE ME, at the Cily/ Municlpalty of personally appeared the
following:
APPLICANTT GOVT.N ISSUEDIDNO DATEISSUED PLACE
ISSUED

LICENSED ARCHITECT OR CIVIL ENG NEER GOVT.N ISSUED ID NO 04TE ISSUED PLACE ISSUED
(FUi-Ume Inspector and Suparvisor of Construction Works)

whose signatures appear herinabove, known to me the same person wha executei this standard prescribed form and acknowiedged to me that the same is their frea and
voluntary ac and deed.
WITNESS MY HAND AND SEAL on the date and placo above writen.
Doc No:
Page No
Book No NOTARY PUBLIG
ries of
BOX6 ( TO ACCOMPLISHED BY THE PROCESsING AND EVALUATION DIVISION)
BASIS OF
ASSESSED FEES DATE DATE AMOUNT ASSEESSED BY
ASSESSMENT
FOR ZONNING (ZONING ADMINISTRATOR:
LOCATIONAL/ZONING OF LAND
FOR FIRE SAFETY (BFP):
FIRE CODE CONSTRUCTION TAX

HOTWORKKS
FOR BUILDINGI STRUCTURE
(OBO):
FILLING FEE

LINE AND'GRADE
FENNG
ARCHITECTURAL
CIVIL/STRUCTURAL
ELECTRICAL
MECHANICAL

SANITARY

PLOMING
FLECTRONIC
INTERIOR
EXCAVATION
SIGNAGE
PENALTIES
SURCHARGE
OTHERS: ANCILLARY

TOTAL:
TERMS AND CONDITIONS:
1. The Owner/Applicant shall Accomplish the Prescribe Applicotion Form, with the
assistance ofthe concerned design professional/s or the Architect/Civil Engineer,

hired/commissioned by him/her as full-time inspector/supervisor of the construction

works, byfilling up the necessary data/ information required thereat.

thave read this form, understood its contents and consent to the processing
of my personal data. I understand that my consent does not preclude the
existence of other criteria for lawful processing of personal data, and does not
waive any of my rights under the Data Privacy Act of 2012 and other applicable
laws.

Owner Applicant
(Signature Over Printed Neme)
Form No.: 77-001S
Republic of the Philippines
DEPARTMENT OF PUBLICWORKS AND HIGHWAYs
Office of the City Building Official

District/City/Municipality
Area Code
APPLICATION NO.: PERMIT NO.:
SANTTARY/PLUMBING PERMIT

Date of Application Date iSUEd

Box1(To be accomplished by Sanitary.Engineer/Master

Name of Owner Applicant
Plumber,in print).
Last Name, First Name, M Tax ldentiicetonNo.

Address No. Street, Brgy., Municipality Telephone No.

Location of Installation No. Street, Brgy., Municipality

Scope of Work
Addition of Other's (Specity)
New Installation Repair of
Removal of
USE OR TYPE OF OCCUPANCY
Residentia Agricutural
Commercial. Parks, Plazas, Monuments
Industrial Recreatianal
Institutiona Others (Specify}-
FiXTURE8 TO BE INSTALLED
aty New Existing Kind of New Existing Kind of
Fixtures Fixtures Fixtures Fixtures Fixtures. Fixturess
Water Closet Bidette
Floor Drain Laundry Tays
Lavatories Dental Cuspidor
Kitchen Sink Gas Heater
Faucet Elect. Heeter
Shower Head Water Boier
Water Meter Drfnking Fountain
Grease Trap Bar Sink.
Bath Tubs Soda Fourntain Sink
Slop Sink Lab Sink
Urinal Sterilizer
Aircon Unit Swimming Pool
H20 Tank/Resvr Others(Specify)
Tota Total
Water Distribution System Sanitary Sewr System Storm Drainage Systerm
Water Supply
Waste H20 Treatment Plant Surface Drainage
ShallowWell
Septic Vault/ImhOff Tank Street CanaB
Deep Well&Pump Set Water Course
City/Munlclpel Water System Sanitary Sewer Connection
Sub-Surface Sand Filter
Others
Box2 (To be accomplshed by Building Official)
ACTION TAKEN
Pernit fs hereby grainted to bvetal the sanitary/plumbirng finure
enumerete hereln subjeot to the folloeing consiton;
1. propossdtntalletion shell be in sccordance with
That the
apprved ptansfiled with this, office and in conformity with the
National Building Code.
2. Thataduly icensed Banitary Engineer/Messtor
Plurtber e
engagedto uindertakethenstalerlon/construction. ARCH. PAVEL D. HALOG
3. Thatacertific te of completoh duly signed by a Sanitary CITY BUILDING OFFICIAL

Engr/Mester Pumber in chergeo installation shal be

of
submitted not.leter than beven (7) days ater completion
the Installetlon ******

4. That a ocerlihoate, of final spection and a csrificate of DATE

occipaney bosocured pror to the actual occupancy of tha
builting
 NLIMBER OF STOREYS OF BULDING TOTAL AREA OF BUILDING/SUBDIVISION
Sq.m.
Proposed Date Total Cost of Installation Php
Start of Installation repared by
Expected Date of Completion
Box 3 ( to be
acoomplished by Division/Section Concerned)
Building Documents
Sanitary Plumbing Plans and Specs Cost Estimates
Bill of Materials Others (Specify )
Box 4 ( to be accomplished by Division/Section Concerned)

Amount Assesed By O.R. Number Dete Pald

Box 5 ( to be accomplished by Division/Sectian Concerned)

Noted: IN OUT
Chief, Processirig Div./Sect. Lime Date Time Date Action/Remarks. Processed By
Receiving snd Recording
GeodeticLine and Grade)
Sanitary
We hereby affix our hands signifying our conformity to the information herein above retfoth.
Box 6
Sanitary Engr.(Master Plumber PRC Reg.No.
Sanitary Engr./Master Plumber PRC Reg.No.
Signed and Sealed Plans &Specs **** n-Charge of Instaliation
Print Name **** *** Print Name
Address * * * Address
PTR No. TIN PTR No. TIN
Date issued Date lssued
Place lssued Signature Place lssued Signature

Box 7

Signature ***Y:

Applican

Res. Cert. No.

Date lssued
Place Issued
Form No.: 77-001-S
Republic of the Philippines '

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

Office of the City Building Oicleal

DistrictCity/Municipality
Area Code
APPLICATION NO.: PERMIT NO.:

SANITARY/PLUMBING PERMIT

Date of Application Date lsied

Box1(To beaccomplished by SanitaryEngineer/Master Plumber,Inprint)
Last Name, First Name, M.l. Tax ldenthficetion No.
Nameof Owner/Applicant
Address No. Street, Brgy., Municipality .Telephons No.

Location of Installatton No. Street, Brgy, Municipality

Scope of Work
Additionnof Other's (Specify)
New Installation Repair of 0T.

Removal of
USE OR TYPE OFOcCUPANCY
Residentia Agricultural
Cormmercia Parks, Plazas, Monuments.
Industrial Recreationa
Institutional Others(Specify-
FIXTURE8 TO BE INSTALLED
ty New Existing Kind of Qty New Existing Kindof
Flxtures Fixtures Fixtures Fixtures Fixtures Fixtures
Water Closet Bidette
Floor Drain Laundry Trays
Lavatories Dental Cuspidor
Kitchen Sink Gas Heater
Faucet Eleot. Heater
Shower Head Water Boier
Water Meter - Drinking Fóuntain
Grease Trap Bar Sink
Bath Tubs Soda Fountain Sink
Slop Sink Lab Sink
Urinal Sterilizer
Aircon Unit Swimming Pool
H20 Tank/Resvr. . Others(Specify)
Total TOtal

Water Distribúton System Sanitary Sewr System Storm Drainage System

Water Supply
Shallow Wel * * * *
Waste H20 Treatment Plant Surface Drainage
Deep Well&Pump Set Septic VaultimhOff Tank Street Canal
City/Munlclpel Water Systern Sanitary Sewer Connection Water Course
Sub-Surface Sand Filter
Others
Box 2 ( Tobe accomplehed by Building Official)
ACTION TAKEN
Pernit fs hiereby grantedainetallthe sanilary/plumbing fixura
onumerete.herein subjecl to thefollowdng consitjon:
1. That the proposedtnetaletibh shell be in edcordance with
apprved plainsfiled withthie, office and in conformity with the
National Building Code.
2. Thataduy lcensed antery Engineer/Mesior Plumber be
engeged to underiake thefnetalarión/construction. ARCH. PAVEL D.HALOG
3, That'acertificte of compietion culy signed by a Sanitary CITY BUILDING OFFICIAL

EngrMester Piymber in charge o installation shall be

submitted not. later than seven (7) days aftercomplefion of
thelastalletlon
4. That a ceirthfioats,af finel Inspectionand a ceriicste o DATE
occupancy be.secured prior to the actual occupancy of iha
buliding.
 NLIMBER OF STOREYS OF BUILDING TOTAL AREA OF BUL.DING/SUBpVISION

Sq.m.
Proposed Date. Total Cost of Installation Php
Start of Installation
reparecd by
Expected Date of Completion

Box3 ( to be accomplished by Division/Section Concerned)

Building Documents
Sanitary Plumbinig Plans and Specs. Cost Estimates
Bill ofMaterials Others ( Specify )
***

Box 4 (to be accomplished by Division/Section Concerned)

Amount Assesed By O.R. Number Dete Patd

Box 5( to be accomplished by Division/Sectian Conicemed)

Noted IN OUT
Chief, Processirig Div./Sect. Time Date Time Date Action/Remarks Processed By
Receiving and Recordin
Geodetic(Line and Grade)
Sanitary
We hereby affix our hands signifying our conformity to the information herein above retfoth
Box 6
Sanitary Engr.[ Master Plumber PRC Rag.No.
Sanitary Engr./Master Plumber PRC Reg. No.
Signed and Sealed Plans &Specs. n-Chargeof Installation
Print Name Print Namne
Address Address
PTR No. PTR No TIN
Datelssued Date issued
Place lesued Signature Place lssued Signature

Box 7
* ******

Signature
Applicani

Res. Cert.No. * *********** * *

Dete lssued
Place Issued
 .

NBC FORM A-03

.
BULOINO PENMITODWIEkON

Republic of the Philippines

ITY OR SnJOSEPEL MONiE
Province of Bulacan ORLOSURiSTLATERN PARANE
CITY OF SAN JOSE DEL MONTE
3 Jase De HG9,5Ul8Cr

OFFICE OF THE CITY BUILDING OFFICIAL

ELECTRICAL PERMIT
APPLICATION NO. ELECTRICAL PERMIT NO.. BUILDING PERMIT NO.

BOX 1 (TO BEAGGOMPLIGHED IN PRINT 9Y THE DWNERJAPPLIGANT

OWNERIAPPUCANT AST NAME FiRSTNAME M. N

FORGONSTRUCTION OWNED FORMOFOWNERSHP USE ORCHARACTER OF ACCUPANCY

BYAN ENTERPRISE CITYIMUNICIPAUTY ZIP CODE TELEPHONE NO.

ADURESS NO. STREET BARANGAY

LOCATION OF CONSTRUCTION: LOT VO. 8LK. NO * * TAX DEC. NO.

STREET. :BARANGAY crYMUNICIPALITY OF

SCOPE QF WORK
NEW INSTALLATION RECONNECTION DF SERVIGE ENTRANGE. RELOCATION OF SERVICE ENTRANCE

ANNUAL INSPECTION SEPARATION OFSERVICEENTRANCE OTHERS (spect)

TEMPORARY UPGRADING OF SERVicE ENTRANCE
SUMMARY OF ELECTRICAL LOADSICAPAGITIES APPLIED FOR

TOTAL CONNECTEDLOAD OTAL TRANSORMER CAPACITY TOTAL GENERATOR/UPS CAPACIY

KVA KVA KVA

.

BOX 2 TO BE AGONGPLIBHEDIN PRINT EYTHE DESIGN PROFESSIONAL -- -- -

DESIGN PROFEBSIONAL, PLANS AND 6PECIFICATIONSs

Acdiese
T
PRC No.
Date Vaicity
PROFESIONAL ELECTRICAL ENGINEER PTR. No. oate lssUed
(Signed anid Seeled over Prinled Neme) ssuGd at
**
TIN
BOX 3

SUPERVISORIN-CHARGE DF ELECTRICAL WORKS

PROFESSIONAL ELECTRIÇALENGINEER REGISTERED ELECTRIGAL ENGINEER REGISTERED MASTERELECTRICIAN

UatA
(SIgnad arid Sealad Over rinted Name)

PRC. No (Valldiy ---

PTR. No. Date lssUed

TIN
ssUed at
Address ***
*** *******

BOX 4 BCX
BUHLDING OWNER fWITAIY CONSENT 0T
OWNER

* (Sgnatue Over Printed Nane!

ignature Qver Printed Name)

Addrest
Adidress
C.T.C No. Date lssUBI PCe JSSed CT.CNo. Dale IsSLEN

* * * * * *
 , .

.
..

TO BE ACCOMPLJOHDY THE PROCEDBING &EVALUATIQN DVINION 3

'

8OX '.'

REGEVED BY: DATE

FIVE (6) SETS OF ELECTRIAL DOcUMENTS
ELECTXIÇAL PLANs AND SPECIFICATIONS LEXPEUTED DATE oF COMPLETIONINsTALLATIONcoNSTRUCTION

SPECAL FUTURESAND EQUIPMENT

PROPOSED sTARTING DATE OF INSTALLATION oTHERs (Spectly)
CONSTRUCTION

BOX 7

PROGRES8 FLOW
N
OUT PROCESSED BY:
DATE TIME DATE TIME ENGRJOSEG. PUNSALANG JR.
ELECTRICAL ELECTRICALENOINESR
(8gnetareOer Prirded Name
OTHERS Epecy.-
PRC Reg. No 0011991
Valldiv
OXB
ACTION TAKEN:
PERMIT I HEREBY 1sUED SUBJECT TO THE FOLLOWING

Thet the propoaed eloctricat worko shallbe in aceordanoo with tie efectical plans led witi this omica and In
confority wth the provistons pf tie teteot Philkppihes Eleçtricel Codep, the Netdona Bulding Code and its IRR
2. Thet priortoary lectcat tnsiallaton, the Owner.Permtee shall aubmita duly accomplished prescrioed Notice
ofConstructiontothe Offloe of the Bulding Officlal.
3. That for installed alectrical capecity of 20b amperes and above at 230 vots nominal and ebove, a specialty electrical
contractordulyloansed by the Philippive Contractore Acoreditaton Board (PCAB) shal be required:
That a duly licensed elocrioal pracltloner shail be In-charge of theinstallaton, and that upon ompletion of the
etectrical works, he ahell submit the entry of the logbook duly »lgned and sealéd to the OBO inciuding a8-bulit
plaris and ather dosuinente. He shatl aiao açcompllsh the Gerttioate of Comptetion statng that the electical woiks
conform totieprovielons of the Phlippine Electrical Building Code and its IRR.
That thiepeml lsnulland vold unless accompanied, by thie buldirg permit except ftor projects invoiving purely
iecticatworkela which caee only the building permit number of the exioing bulding/structure shall be requlred
That a Certficate of Finel Electrical inspectionCF) shal! be secured prorto the actuat occupancy of the bulding.

Thatthis pemit naltbeposted et the door or ste of work.

PERMIT ISSUED BY:

ARCH.PAVEL D. HALOG
CITY BUILDING OFFICIAL
(Slgnature Over Printed Neme)
 BULOINO PENMITO ONIBtON
NBC FORM A-03

Republic of the Philippines troR SAMJOSipELMONT

Provinçe ofBulacan WORLOSUNGEST LATERN PARADE
CITY OF SAN JOSE DEL MONTE
S3% Jase del l40e8,BUk8pa
.

OFFICE OF THE CITY BUILDING OFFICIAL

.
ELECTRICAL PERMIT
APPLICATION NO ELECTRICAL PERMIT NO. BULDING PERMIT NO.
LLLLLLLLL
BOX 1 (TO BE AGCOMPLISHED IN PRINT BY THE DWNERAPPLIGANT)
OWNERAPPLICANT LASTNAME FIRST NAME M. TIN

FOR CONSTRUCTION OWNED TFORM OFOWNERSHIP USE ORCHARACTER OF ACGUPANCY

BYAN ENTERPRISE CITYIMUNIGIPALTY 21P CODE TELEPHONE NO.
ADDRESS NO. STREET BARANGAY
*** ***** *********** *********** *******

LOCATION OF CONSTRUCTION: LOT NO. BLK. NO TCT NO T A X DEC. NO.

$TREET BARANGAY crrYMUNHCIPALITY OF

SCOPE OF WORK
NEW INSTALLATION RECONNECTION OF SERVICe ENTRANCE RELOGATION OF SERVICE ENTRANCE
ANNUAL INSPECTION SEPARATION OF SERvICEENTRANCce oTHERS (spect)
TEMPORARY UPGRADING OF SERVICE ENTRANCE
sUMMARY OF ELECTRICAL. LOADSICAPACITIES APPLIEDFOR

TOTAL CONNECTED LOAD 1'TAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS OAPAGITY

KVA . - KVA KVA

IN PRINT BY THE DESIGN PROFESSIONA

BOX 2 (O BE AGGOMPUEBHED
DESIGN PROFE5SIONAL PLANS AND 5PECIFIGATIONS
Addiese
PRC No. Valdry
PROFEBSIONAL ELECTRICAL ENGINEER PTA No. ate lssu6d
-
(Signed and Seefed Over Printed Neme). 9sued a TIN
BOX 3
SUPERVISOR / IN-GHARGE OF ELECTRICAL WORKS
PROFSSIONAL ELECTRIÇAL ENGINEER REGISTERED ELEGTRICAL ENGINEER REGISTERED MASTER ELECTRICAN

(Signad arid Søalad Over Prlnted Natie)

* ~************* ***** ********** *

RRC. No ******* **********""

Validily
PUR. No ate lssued
Issued af TIN -...

Address .
CGX G
BOX WITA IYCONSENT OT OWNER
BUILDING OWNER

(Sigrature Over Printod Name)

(Slgnatue Ovar P:inted N:ume)

|Addresá
Adirese
C.T.C No. Date ssUEU PC SSHd CTCNo. Date Issuei
 . . .

ro BE ACGOMPJHED BY THE PROGESSING &EVALUATION DIVIsION

30X6
RECEVED BY DATE
FIVE (6) SETS OF ELESTRICALL DOCUMENTS

LELECTRICAL PLANS AND SPÉCIFICATIONS LEXPECTED DATË OF coMPLETIONINSTALLATKONCONSTRUCTION

SPEGAL FUXTURES AND EQUIPMENT
PROPOsed sTANTING DATE OF NSTALLATION OTHERS(Spectly)
CONSTRUCTION

BOX 7

PROGRESS FLOW
OUT
PROCESSEDBY
DATE TME DATE ME ENGR:J9SE.C. PUNSALANGJR
ELECTRICAL ELECROCAL ENGNE
(sgnsture Over Printed Name)
OTHERS (8peciy
PRC Reg. No 0011991
Valdiy
BOX8,
ACTION TAKEN;
PERMIT, o HEREBY 183UED 8UBJECT TO THE FoLLOWING3

Thet the. propose electrica worko ohall be In accordance with the efectrical plans i e d wii thie omce and in
oonfontly with the provistons of tie leteet Phtilippihes Eleçtricel coves, the Nevorna Bulding Code and ts IRR
Thet priorto ary eiecutcal tnstallaton, the Owner.Pormittee shatt submit duly accomplshed prescrioed Notice
of Construction to the OmMice of the Bulding Official.
That for ineteied olectricel capecity of 20d amperes and above at 230 volts nominel and above, a specialty oBectrikal
contractordulylcensed by the Phlppine Contractore Accredltation Board (PCAB) shall be requlred.
4 That a duly licesed olectrical prectitioner shell be In-charge ot the Instalaton, and that upon ompletfon of the
electioel warke, he ahell ubmit the entry of the logbook duly signed and sealed to the oBO Including as-bulit
plaris and ather doouniente. He ahatf aiso acoompllah the Gertthaete of Gompleton statng that the olectrical works

confoim totheprovielons of the Phlipprne Electrlcal Buldng Code and Ite IRR.
That this pemit lenulland vold unless accompanied, by the bullding permit except for projecte invoving purely
tectrtcal worke lo which ceee only the bullaing pemit number of the exietng bulding/structure shall be requlred.
Thet a Certificats of Final Electrical Inspection(CF) shat! be secured piorto the actual occupancy of the buildlng.

That thla permit shal be posted at the door or slte of work.

PERMIT IsSUED BY:

ARCH,PAVEL D. HALOG
CITY BUILDING OFFICIAL
(Slgnature Over Printed Name)
 .

NBC FORM A-03 BULDING PENNTO DWSION

Republic of the Philippines

CITORAJOEPLMONI
Provinçe of Bulacan RLUSHOESTLAHERN ARADE
CITY OF SAN JOSE DEL MONTE
$1 Jose Oel 140:1?,8ulocar

OFFICE OF THE CITY BUILDING OFFICIAL

ELECTRICALPERMIT
APPLICATION NO. ELECTRICAL PERMIT NO. BUILDING PERMIT NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THEpWNERAPPLIGANT)

OWNERAPPLICANT ASTNAME FIRSTNAME TIN

FOR CONSTRUCTION OWNED FORM OFOWNERSHIP USE OR GHARACTER OF ACCUPANCY

AN ENTRPRISE
ADDRESS NO. STREET BARANGAY CITYMUNICIPALTY Z1P CODE TELEPHONE NO.

LOCATIONOF CONSTRUCTION: LOT NO.. 8LK. NO TCTNO TAX DEC. NO.

$TREET BARANGAY cITYAMUNICIPALITY OF

-- -

SCOPE QF WORK
NEW INSTALLATION RECONNECTION OF SERVICE ENTRANGE RELOCATION OF SERVICE ENTRANGCE
ANNUAL INSPECTION SEPARATION OF SERVIGE ENTRANCE OTHERs (9pect).
TEMPORARY UPGRADING OF SERvICE ENTRANCE

sUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAACITY TOTAL GENERATOR/UPS CAPACir

KVA KVA KVA

BOX 2 (ro BE AGGOMrLIBHEÓ IN PRINT BY THE DESIGN PROFE3SIONAL,

- - - - - -

DESIGN PROFESSIONAL, PLANS AND 6PECIFIGATIONS ---~

AGes8
Date PRC No. Valkty
PTR. No. Dale lssued
PROFEBSIONAL ELECTRIGAL ENGaNEER
(Signed anid Seeled Over Printed Neme) uei
ISSUGo
.
TEN
BOX 3
* * ***** ********
SUPERVISOR/ IN-GHARGE OF ELECTRICAL WORKS
REGISTERED ELETTRICAL ENGINEER
LPROFESSIONAL ELECTRICAL ENGINEER REGSTEREO MASTER ELECTRICIAN

UtA
(Signad arid Seatad Over Prlnted Narme)
-
****

PRC. No. * * * * * " * *****" ValidtyY

PR, No ***~****************************
ate l6sUed
****

ssued at [TIN
***

Addrees
BOX4
BUILDING OWNER WITA MY CONSENT

(Slgatore Over Prirnted Name) (Sgnøtu Ovar Pinted Nae)

Addresu& Addrus
C.T.C No. Date l88UB PCHSSAeu CT.CNo. Data lssuECI