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 FIRE SAFETY EVALUATION CLEARANCE

APPLICATION NO AREA NO.

BOX 1 ( TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT )

OWNER LAST NAME FIRST NAME M.I. TIN NO.
DO NOT FILL-UP (PSA USEN ONLY)
FOR CONSTRUCTION OWNED FORM OWNERSHIP MAIN ECONOMIC ACTIVITY OF BUSINESS
BY AN ENTERPRISE

ADDRESS: NO. STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TEL NO.

LOCATION OF CONSTRUCTION: LOT NO: BLK. NO: TCT NO: CURRENT TAX DEC NO:
STREET______________________BARANGAY _________________CITY/MUNICIPALITY OF _____________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ____________ RAISING

ERECTION______________ CONVERSION____________ ACCESSORY BUILDING/STRUCTURE

ADDITION ______________ REPAIR _________________ LEGALIZATION OF EXISTING BUILDING

ALTERATION____________ MOVING_________________ OTHERS (SPECIFY)

USE OR TYPE OF OCCUPANCY
GROUP A: RESIDENTIAL(DWELLINGS) GROUP G: MEDIUM INDUSTRIAL
SINGLE DUPLEX RESIDENTIAL R-1,R-2 STORAGE/WAREHOUSE (FOR HAZARDOUS/
OTHERS _____________ HIGH FLAMMABLE MATERIALS
FACTORY (FOR HAZARDOUS/HIGHLY
GROUP B: RESIDENTIAL FLAMMABLE MATERIALS
HOTEL MOTEL TOWNHOUSE OTHERS_____________
DORMITORY BOARDDING HOUSE,
RESIDENTIAL R-3,R-4,R-5 LODGING HOUSE
OTHERS _____________ GROUP H: ASSEMBLY (OCCUPANT
LOAD LESS THAN 1,000)
GROUP C: EDUCATIONAL & RECREATIONAL THEATER, AUDITORIUM, CONVENTION HALL,
SCHOOL BUILDING SCHOOL AUDITORIUM, GRANDSTAND/ BLEACHER
CIVIC CENTER CLUBHOUSE GYMNASIUM OTHERS_____________
OTHERS_____________ CHURCH AND
RELIGIOUS STRUCTURES
GROUP D: INSTITUTIONAL GROUP I: ASSEMBLY (OCCUPANT
HOSPITAL OR SIMILAR STRUCTURE LOAD 1,000 OR MORE)
HOME FOR AGED COLISEUM, SPORTS COMPLEX
GOVERNMENT OFFICE CONVENTION CENTER AND SIMILAR
OTHERS_____________ STRUCTURE
OTHERS_____________
GROUP E: COMMERCIAL
BANK STORE
DRINKING / DINING GROUP J: (J-1 AGRICULTURAL)
ESTABLISHMENT BARN(S), GRANARY, POULTRY HOUSE(S)
SHOP (e.g. DRESS SHOP, TAILORING SHOP, PIGERRY,GRAIN MILL, GRAIN SILO
BARBER SHOP, ETC.) OTHERS_____________
SHOPPING CENTER / MALL
OTHERS _____________
GROUP J: (J-2 ACCESSORIES)
GROUP F: LIGHT INDUSTRIAL PRIVATE CARPORT / GARAGE, TOWER,
FACTORY/PLANT (USING INCOMBUSTIBLE/ SWIMMING POOL, FENCE OVER 1.80m
NON-EXPLOSIVE MATERIALS) STEEL/CONCRETE TRANK
OTHERS_____________ OTHERS_____________

OCCUPANCY CLASSIFIED TOTAL ESTIMATED COST: P

NUMBNER OF UNITS BUILDING COST OF EQUIPMENT INSTALLED
NUMBER OF STOREY ELECTRICAL P
TOTAL FLOOR AREA SQ.M. MECHANICAL P
LOT AREA SQ.M. ELECTRONICS P
PLUMBING P
PROPOSED DATE OF CONSTRUCTION:_____________________ ECXPECTED DATE OF COMPLETION:_________________________
BOX 2
FULL-TIME INSOECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
ADDRESS:

ARCHITECT OR CIVIL ENGINEER PRC NO. VALIDITY

(SIGNED AND SEALED OVER PRINTED NAME) PTR NO. DATE ISSUED
DATE: ______________ ISSUED AT TIN
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE
DATE DATE
(SIGNED AND SEALED OVER PRINTED NAME) (SIGNED AND SEALED OVER PRINTED NAME)
ADDRESS ADDRESS
GOVT. ISSUED ID NO DATE ISSUED PLACE ISSUED GOVT. ISSUED ID NO DATE ISSUED PLACE ISSUED
BOX 5
REPUBLIC OF THE PHILIPPINES ) S.S.
CITY/MUNICIPALITY OF ______________________________ )
BEFORE ME, at the City/ Municipality of on personally appeared the
following:

APPLICANT GOVT.N ISSUED ID NO DATE ISSUED PLACE ISSUED

LICENSED ARCHITECT OR CIVIL ENGINEER GOVT.N ISSUED ID NO DATE ISSUED PLACE ISSUED
(Full-time Inspector and Supervisor of Construction Works)

whose signatures appear herinabove, known to me the same person who executed this standard prescribed fform and acknowledged to me that the same is their free and
voluntary act and deed.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc No:
Page No:
Book No: NOTARY PUBLIC
Series of
BOX 6 ( TO ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

BASIS OF
ASSESSED FEES DATE AMOUNT ASSEESSED BY
ASSESSMENT
FOR ZONNING ( ZONING ADMINISTRATOR:
LOCATIONAL / ZONING OF LAND

FOR FIRE SAFETY (BFP):

FIRE CODE CONSTRUCTION TAX
HOTWORKS

FOR BUILDING/ STRUCTURE

(OBO):
FILLING FEE
LINE AND GRADE
FENCING
ARCHITECTURAL
CIVIL / STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
EXCAVATION
SIGNAGE
PENALTIES
SURCHARGE
OTHERS: ANCILLARY

TOTAL:
TERMS AND CONDITIONS:

1. The Owner/Applicant shall Accomplish the Prescribe Application Form, with the
assistance of the concerned design professional/s or the Architect/Civil Engineer,
hired/commissioned by him/her as full-time inspector/supervisor of the construction
works, by filling up the necessary data / information required thereat.

I have 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 Name)
 REPUBLIC OF THE PHILIPPINES
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE

OFFICE OF THE CITY BUILDING OFFICIAL

AREA CODE 1420R
APPLICATION NO BUILDING PERMIT NO.

BUILDING PERMIT
DATE OF APPLICATION DATE ISSUED
ORIGINAL RENEWAL
BOX 1 ( TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT )
OWNER LAST NAME FIRST NAME M.I. TIN NO.

FORM OWNERSHIP MAIN ECONOMIC ACTIVITY OF BUSINESS

BY AN ENTERPRISE

ADDRESS TEL NO.

LOCATION OF CONSTRUCTION
SCOPE OF WORK 1 NEW CONSTRUCTION _____________ OTHERS (SPECIFY)
2 ADDITION OF____________________ 6 ______________OF ___________
3 REPAIR OF_______________________ 7 ______________OF ___________
4 RENOVATION OF__________________
5 DEMOLITION OF__________________ NUMBER OF UNITS ______________

USE OR TYPE OF OCCUPANCY

RESIDENTIAL INDUSTRIAL
11 SINGLE 31 FACTORY/PLANT
12 DUPLEX 32 REPAIR SHOP/MACHINE SHOP
13 ROWHOUSE/ACCESORIA 33 REFINERY
14 OTHERS (SPECIFY)_____________ 34 PRINTING PRESS
35 WAREHOUSE
COMMERCIAL 36 OTHERS (SPECIFY) ____________________
21 BANK INSTITUTIONAL
22 STORE 41 SCHOOL
23 HOTEL/MOTEL ETC. 42 CHURCH AND OTHER RELIGIOUS STRUCTURES
24 OFFICE CONDOMINIUM/BUSINESS OFFICE BUILDING 43 HOSPITAL OR SIMILAR STRUCTURE
25 RESTAURANT, ETC. 44 WELFARE AND CHARITABLE STRUCTURE
26 SHOP (e.g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC.) 45 THEATER, AUDITORIUM, GYMNASIUM, COURT
27 GASOLINE STATION 46 OTHERS (SPECIFY) ____________________
28 MARKET
29 DORMITORY OR OTHER LODGING HOUSE AGRICULTURAL
30 OTHERS (SPECIFY)_____________ 51 BARN(S), POULTRY HOUSE(S), ETC.
OTHER CONSTRUCTION 52 GRAIN MILL
60 OTHERS (SPECIFY) ____________________ 50 OTHERS (SPECIFY) ____________________

STREET FURNITURE, LANDSCAPING & SIGNBORADS

71 PARKS, PLAZAS, MONUMENTS, POOLS, PLANT BOXES, ETC.
72 SIDEWALKS, PROMENADES, TERRACES, LAMPOSTS, ELECTRIC POLES, TELEPHONE ROLES, ETC.
73 OUTDOOR ADS, SIGNBOARDS, ETC.
74 FENCE ENCLOSURE

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

BUILDING DOCUMENTS (FIVE SETS EACH)
SITE DEVELOPMENT AND LOCATION PLAN MECHANICAL PLANS & SPECIFICATIONS
ARCHITECHTURAL PLAN & SPECIFICATIONS LOGBOOK (1COPY)
STRUCTURAL DESIGN & COMPUTATIONS OTHERS (SPECIFY)
SANITARY/PLUMBING PLANS & SPECIFICATIONS
ELECTRICAL PLANS AND SPECIFICATIONS
BOX 3 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
ACTION TAKEN:
PERMIT IS HEREBY GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:
1 THAT THE PROPOSED CONSTRUCTION/ADDITION/REPAIR/RENOVATION/DEMOLITION/
INSTALLATION ETC. SHALL BE IN CONFORMITY WITH THE NATIONAL BUILDING CODE
(P.D. 1096) AND ITS CORRESPONDING IMPLEMENTING RULES AND REGULATIONS ARCH. PAVEL D. HALOG
2 THAT A DULY LICENSED ARCHITECT/CIVIL ENGINEER HAS BEEN ENGAGED TO
PREPARE PLANS AND SPECIFICATIONS AND TO UNDERTAKE THE SUPERVISION/ BUILDING OFFICIAL
INSPECTION OF THE CONSTRUCTION OF THE PROJECT.
3 THAT A CERTIFICATE OF COMPLETION DULY SIGNED AND SEALED BY THE DESIGNING
ARCHITECT/ENGINEER AND THE ARCHITECT/ENGINEER INCHARGE OF CONSTRUCTION DATE
SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE
CONSTRUCTION OF THE PROJECT.
4 THAT A "CERTIFICATE OF OCCUPANCY" SHALL BE SECURED PRIOR TO ACTUAL OCCUPANCY
OF THE BUILDING

NOTE: THIS PERMIT MAY CANCELLED OR REVOKE PURSUANT TO SECTIONS 305 & 306 OF THE NATIONAL BUILDING CODE
To be accomplished in five copies, one each for: applicant (original).Assessor,National Statistics Office,Building Official,Fire Department
,
BOX 3A (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT) DO NOT FILL (NSO USE ONLY)
TOTAL ESTIMATED COST COST OF NUMBER OF STOREYS ___________________
BUILDING P __________ EQUIPMEN TOTAL FLOOR AREA ____________________
ELECTRICAL P __________ INSTALLED PROPOSED DATE
MECHANICAL P __________ P_________ OF CONSTRUCTION______________________
PLUMBING P __________ P_________ EXPECTED DATE
OTHERS P __________ P_________ OF COMPLETION ________________________

MATERIAL OF CONST ____________________

TOTAL COST P __________ (WOOD,CONC,STEEL,MIXED) ______________
BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

ASSESSED FEES
AMOUNT ASSESSED BY O.R. NUMBER DATE PAID

LINE and GRADE

BUILDING

PLUMBING

ELECTRICAL

MECHANICAL

OTHERS REVISED :

TOTAL CHIEF, PROCESSING DIVIDION/SECTION

BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
PROGRESS FLOW

NOTED: IN OUT ACTION/REMARKS PROCESSED BY

CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIME DATE

RECEIVING and RECORDING

LAND USE and ZONING

GEODETIC (LINE and GRADE)

ARCHITECTURAL

STRUCTURAL

SANITARY

ELECTRICAL

MECHANICAL

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX 6 BOX 8
ARCHITECTURAL/CIVIL ENGINEER PRC REG. NO.SIGNATURE
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:
BOX 7 BOX 9 (TO BE ACCOMPLISHED BY LOT OWNER)
ARCHITECTURAL/CIVIL ENGINEER PRC REG. NO.TCT/OCT NO.
IN-CHARGE OF CONSTRUCTION
PRINT NAME PRINT NAME OF LOT OWNER

ADDRESS ADDRESS

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

SIGNATURE TIN SIGNATURE TIN

ARCH. PAVEL D. HALOG
,
Form No.: 77-001-S
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
Office of the City Building Official

District/City/Municipality
Area Code _______

APPLICATION NO.: PERMIT NO.:

SANITARY/PLUMBING PERMIT
Date of Application Date Issued
Box 1 (To be accomplished by Sanitary Engineer/Master Plumber, in print)
Name of Owner/Applicant Last Name, First Name, M.I. Tax Identification No.:

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

Location of Installation No. Street , Brgy., Municipality

Scope of Work
Addition of Other's (Specify)
New Installation Repair of ___________ of ___________
Removal of ___________ of ___________
USE OR TYPE OF OCCUPANCY
____ Residential ____ Agricultural
____ Commercial ____ Parks, Plazas, Monuments
____ Industrial ____ Recreational
____ Institutional ____ Others (Specify)
FIXTURES TO BE INSTALLED
Qty. New Existing Kind of Qty. New Existing Kind of
Fixtures Fixtures Fixtures Fixtures Fixtures Fixtures
____ ____ ____ ____ Water Closet ____ ____ ____ Bidette
____ ____ ____ ____ Floor Drain ____ ____ ____ Laundry Trays
____ ____ ____ ____ Lavatories ____ ____ ____ Dental Cuspidor
____ ____ ____ ____ Kitchen Sink ____ ____ ____ Gas Heater
____ ____ ____ ____ Faucet ____ ____ ____ Elect. Heater
____ ____ ____ ____ Shower Head ____ ____ ____ Water Boiler
____ ____ ____ ____ Water Meter ____ ____ ____ Drinking Fountain
____ ____ ____ ____ Grease Trap ____ ____ ____ Bar Sink
____ ____ ____ ____ Bath Tubs ____ ____ ____ Soda Fountain Sink
____ ____ ____ ____ Slop Sink ____ ____ ____ Lab Sink
____ ____ ____ ____ Urinal ____ ____ ____ Sterilizer
____ ____ ____ ____ Aircon Unit ____ ____ ____ Swimming Pool
____ ____ ____ ____ H2O Tank/Resvr. ____ ____ ____ Others(Specify)
Total Total
________Water Distribution System _______Sanitary Sewr System ________Storm Drainage System
Water Supply:
________ Shallow Well _______Waste H2O Treatment Plant ________ Surface Drainage
________ Deep Well & Pump Set _______Septic Vault/ImhOff Tank ________ Street Canal
________ City/Municipal Water System _______Sanitary Sewer Connection ________ Water Course
________ Others _______Sub-Surface Sand Filter

Box 2 ( To be accomplished by Building Official )

ACTION TAKEN:
Pernit is hereby granted to install the sanitary/plumbing fixture
enumerate herein subject to the following consition:
1. That the proposed installation shall be in accordance with
apprved plans filed with this office and in conformity with the
National Building Code.
2. That a duly licensed Sanitary Engineer/Master Plumber be
engaged to undertake the installarion/construction. ARCH. PAVEL D. HALOG
3. That a certificate of completion duly signed by a Sanitary CITY BUILDING OFFICIAL
Engr/Master Plumber in charge o installation shall be
submitted not later than seven (7) days after completion of
the installation. ______________
4. That a certificate of final inspection and a certificate of DATE
occupancy be secured prior to the actual occupancy of the
building.
 .

NUMBER OF STOREYS OF BUILDING TOTAL AREA OF BUILDING/SUBDIVISION

Sq.m.
Proposed Date ______________________ Total Cost of Installation Php
Start of Installation ___________________ Prepared by:
Expected Date of Completion __________

Box 3 ( to be accomplished 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 Date Paid

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

Noted: IN OUT
Action/Remarks Processed By
Chief, Processing Div./Sect. Time Date Time Date
Receiving and Recording
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 Reg.No. Sanitary Engr./Master Plumber PRC Reg.No.
Signed and Sealed Plans & Specs. In-Charge of Installation
Print Name Print Name
Address Address
PTR No. TIN PTR No. TIN
Date Issued Date Issued
Place Issued Signature Place Issued Signature

Box 7

Signature
Applicant

Res. Cert. No.

Date Issued
Place Issued
 BUILDING PERMITS DIVISION
NBC FORM A-03

Republic of the Philippines

Province of Bulacan
CITY OF SAN JOSE DEL MONTE

OFFICE OF THE CITY BUILDING OFFICIAL

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

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF ACCUPANCY

BY AN ENTERPRISE
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK. NO.______________TCT NO.________________TAX DEC. NO.

STREET BARANGAY CITY/MUNICIPALITY OF

SCOPE OF WORK
NEW INSTALLATION RECONNECTION OF SERVICE ENTRANCE RELOCATION OF SERVICE ENTRANCE
ANNUAL INSPECTION SEPARATION OF SERVICE ENTRANCE OTHERS (Specify) _______________________

TEMPORARY UPGRADING OF SERVICE ENTRANCE

SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS CAPACITY

________________ KVA ________________ KVA ________________ KVA

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL

DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
Address

Date PRC No. Validity

PROFESSIONAL ELECTRICAL ENGINEER PTR. No. Date Issued

(Signed and Sealed Over Printed Name) Issued at TIN

BOX 3
SUPERVISOR / IN-CHARGE OF ELECTRICAL WORKS
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN

___________________________________________________ Date _____________

(Signed and Sealed Over Printed Name)

PRC. No. Validity

PTR. No. Date Issued
Issued at TIN
Address
BOX 4 BOX 5
BUILDING OWNER WITH MY CONSENT: LOT OWNER

_____________________________________ Date ___________ Date _______________

(Signature Over Printed Name) (Signature Over Printed Name)

Address Address
C.T.C No. Date Issued Place Issued C.T.C No. Date Issued Place Issued