Republic of the Philippines
OFFICE OF THE CITY BUILDING OFFICIAL
3rd Floor, City Hall Building, Brgy. Pulung Maragul, Angeles City
+63 907 280 4638 /
[email protected] UNIFIED APPLICATION FORM FOR BUILDING PERMIT
SIMPLE COMPLEX*
NEW RENEWAL AMENDATORY
THIS APPLIES ALSO FOR: LOCATIONAL CLEARANCE FIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO. APPROVED NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN
DO NOT FILL-UP (PSA USE ONLY)
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
BY AN ENTERPRISE
ADDRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE CONTACT NO.
LOCATION OF CONSTRUCTION: LOT NO. ________ BLK NO. ________ TCT NO. ______________ CURRENT TAX DEC. NO. ____________________
STREET_____________________ BARANGAY ____________________________ CITY/MUNICIPALITY _______________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR LEGALIZATION OF EXISTING BUILDING
ALTERATION MOVING OTHERS (Specify)
USE OR CHARACTER OF OCCUPANCY
GROUP H: ASSEMBLY (OCCUPANT
GROUP A: RESIDENTIAL (DWELLINGS) GROUP E: COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION HALL,
OTHERS ______________________________________ DRINKING/DINING CENTER/MALL GRANDSTAND/BLEACHER
GROUP B: RESIDENTIAL ESTABLISHMENT OTHERS ______________________________
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING,
DORMITORY BOARDINGHOUSE, BARBERSHOP, etc.) GROUP I: ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS ______________________________ LOAD 1,000 OR MORE)
COLISEUM, SPORTS COMPLEX,
OTHERS _______________________________________ GROUP F: LIGHT INDUSTRIAL CONVENTION CENTER AND SIMILAR
GROUP C: EDUCATIONAL & RECREATIONAL FACTORY/PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS OTHERS _______________________
CIVIC CENTER GYMNASIUM OTHERS ______________________________
CLUBHOUSE CHURCH, MOSQUE, GROUP J: (J-1) AGRICULTURAL
TEMPLE, CHAPEL GROUP G: MEDIUM INDUSTRIAL BARN, GRANARY, POULTRY HOUSE,
OTHERS _______________ PIGGERY, GRAIN MILL, GRAIN SILO
STORAGE/WAREHOUSE (FOR HAZARDOUS/
GROUP D: INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS _______________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/HIGHLY GROUP J: (J-2) ACCESSORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT/GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _______________________________ SWIMMING POOL, FENCE OVER 1.80m,
STEEL/CONCRETE TANK
OTHERS _______________________________________ OTHERS _______________________
OCCUPANCY CLASSIFIED_____________________________ TOTAL ESTIMATED COST: P _____________________________________________________
NUMBER 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: ________________________ EXPECTED DATE OF COMPLETION: _______________________________________________
BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
PRC No. Validity
ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name)
PTR No. Date Issued
Date_____________________________ Issued at TIN
BOX 3 BOX 4
OWNER: WITH MY CONSENT: LOT OWNER/AUTHORIZED REPRESENTATIVE
Date ______________ Date______________
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
Gov’t Issued ID No. Date Issued Place Issued Gov’t 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 Gov’t Issued ID No. Date Issued Place Issued
______________________________________________________ _____________________ _______________ ___________________________________
LICENSED ARCHITECT OR CIVIL ENGINEER Gov’t Issued ID No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)
whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed form 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 (Until December ______________)
Series of ____________
Copy 1: Owner Copy 2: OBO Copy 3: BFP Copy 4: Philippine Statistics Authority
BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
FOR ZONING (ZONING
ADMINISTRATOR):
LOCATIONAL/ZONING OF LAND
FOR BUILDING/STRUCTURE
(OBO):
FILING FEE
LINE AND GRADE (Geodetic)
FENCING
ARCHITECTURAL
CIVIL/STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
SURCHARGES
PENALTIES
FOR FIRE SAFETY (BFP):
FIRE CODE CONSTRUCTION TAX
HOTWORKS
TOTAL
TERMS AND CONDITIONS:
1. The Owner/Applicant shall accomplish the prescribed Application Form, with the assistance of the concerned
design professional/s and/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.
2. The fully accomplished prescribed Application Form, duly notarized, shall be submitted to the concerned Office of
the Building Official, accompanied by the various applicable ancillary and accessory permits, plans and
specifications signed and sealed by the corresponding design professionals who shall be responsible for the
comprehensive and correctness of the plans in compliance to the National Building Code of the Philippines (PD
1096), its Revised IRR and all applicable referral codes and professional regulatory laws, together with the other
documentary requirements pursuant to Section 302 of PD 1096 and its Revised IRR.
ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED CONSTRUCTION/ADDTION/REPAIR/RENOVATION/DEMOLITION/INSTALLATION, ETC. SHALL BE
IN CONFORMITY WITH THE NATIONAL BUILDING CODE (P.D 1096) AND IT’S IMPLEMENTING RULES AND
REGULATIONS.
2. THAT A DULY LICENSED ARCHITECT/CIVIL ENGINEER HAS BEEN ENGAGED TO PREPARE PLANS AND TO
UNDERTAKE THE SUPERVISION/INSPECTION OF THE CONSTRUCTION OF THE PROJECT.
3. THAT CERIFICATE OF COMPLETION DULY SIGNED AND SEALED BY THE DESIGNING ARCHITECT/ENGINEER IN-
CHARGE OF CONSTRUCTION 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 THE ACTUAL OCCUPANCY OF THE
BUILDING.
ISSUED BY:
BUILDING OFFICIAL
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.
___________________________________________________
SIGNATURE OVER PRINTED NAME
OWNER/APPLICANT
