BASIC REQUIREMENTS for LOCATIONAL CLEARANCE

1. Duly accomplished and notarized APPLICATION FORM.

2. Requirements relative to RIGHT OVER LAND.
a. Photo copy of the Certificate of Title, in case registered in the name of the applicant.
b. Original Certified True Copy of the Tax Declaration issued not earlier than three(3)months upon
filing of application.
c. In the absence of Certificate of Title in the name of the applicant, submit pro-forma affidavit.
3. VICINITY MAP showing the existing land uses within the prescribed radius from the boundary of the
subject site;
a. For Regular projects _ minimum of 100m radius (the map need not be drawn to scale provided
that relative distances of existing land uses to the project site of boundaries are indicated).
b. For Special projects – minimum of one(1) kilometer radius and should be drawn to scale.
4. SITE DEVELOPMENT PLAN showing the project site lot area boundaries and dimensions of proposed
structures/improvements within the project site.
5. One set plan
6. Detailed Cost of Materials and specifications signed and sealed by a duly licensed Civil Engineer /
Architect with conformity of the owner.
 Republic of the Philippines
PROVINCE OF KALINGA
CITY OF TABUK
CITY PLANNING AND DEVELOPMENT OFFICE

APPLICATION FOR LOCATIONAL CLEARANCE

Application No.: __________ Date Issued : ___________
Date of receipt : __________ Amount Paid: ___________
MTO/OR No. : __________
NAME OF APPLICANT (Last,First,Middle) NAME OF CORPORATION

ADDRESS /TELEPHONE OF APPLICANT ADDRESS & TEL. OF CORPORATION

NAME OF AUTHORIZED REPRESENTATIVE ADDRESS & TEL OF AUTHORIZED REPRESENTATIVE

PROJECT TYPE PROJECT NATURE

( ) New Development ( ) Other (Specify)
PROJECT LOCATION No.Street/Brgy.City/Municipality PROJECT AREA (in square meter)

RIGHT OVER LAND PROJECT TENURE

( ) Owner ( ) Other (specify) ( ) Permanent
( ) Lease ( ) Temporary
EXISTING LAND USE OF THE PROJECT
( ) Residential ( ) Others (specify) ( ) Tenanted
( ) Institutional ( ) Vacant/Idle ( ) Not Tenanted
( ) Commercial ( ) Agricultural ( specify Crop)
PROJECT COST ( In pesos, write in words and figures)

IS THE PROJECT APPLIED FOR THE SUBJECT OF WRITTEN NOTICE/S FROM THIS BOARD OR THE LOCAL
GOVERNMENT UNIT (LGU) TO PRESENT OR APPLY FOR LOCATIONAL CLEARANCE (LC)?
( ) YES (Pls indicate the following) ( ) NO

Issuing Officer:
Order In Notice:
Date of Notice:

IS THE PROJECT APPLIED FOR THE SUBJECT OF RELATED ACTION/S WITH OTHER OFFICES OF THE
BOARD AND/OR LOCAL GOVERNMENT UNIT?
( ) YES (Pls indicate the following) ( ) NO

Office where similar actions was filed: ( ) NO

Date Filed:
Actions Taken:

PREFERRED MODE OF REALESED OF DECISION:

( ) Pick-up ( ) By mail, address to: ( ) Applicant ( ) Authorized Representative

SIGNATURE OF APPLICANT SIGNATURE OF AUTHORIZED REPRESENTATIVE

Republic of the Philippines

_____________________)s.s.

SUBSCRIBE AND SWORN TO before me this ___ day of ______, 20__, in the City/Municipality of
_______ Province of _____________. Affiant exhibited his/her Community Tax Certificate No.
________________ issued at ____________________ on _____________________.

Doc. No. : ___________

Page No. : ___________ NOTARY PUBLIC
Book No. : ___________
Series No.: ___________
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF KALINGA)S.S

AFFIDAVIT

I, ____________________________________ of legal age, single/marries, Filipino citizen, with postal

address and residence at ______________________________________ after being sworn to in
accordance with law, hereby depose and state the following:

1. That I am the owner of a parcel of land located at ____________________________________

with an area of ____________sq.m, covered by ____________________________________;

2. That the above-mentioned property/ies is/are subject of an application of Locational

Clearance/Certificate of Zoning Certificate for _______________________________________;
(Project – Type)

3. That the above - mentioned property(s) was acquired by way of________________ ___________;
(State whether by sale or inheritance, etc.)

4. That the best of my knowledge, the above mentioned property(s) is/are free from any alien or
encumbrance except ____________________________________;
(indicates lien & encumbrance)

5. That the best of my knowledge, the above mentioned property(s) is/are situated within alienable
and disposable lands and outside lands reserve for the public domain and the same is not utilized for
agricultural purposes;

For agricultural Lands only : That the above mentioned property(s) is/are utilized for agricultural
purposes, particularly for the cultivation of .
(Indicated crops)

That I intended to use ___________________ of the property(s) for _______________________;

. (type of crops)

6. That I am executing this affidavit to attest to the veracity of the aboved mentioned facts thereby
satisfying the requirements of the HLURB relative to my application for Locational Clearance/Certificate
of Zoning Compliance for the above mentioned project.

Affidavit further says nothing.

___________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this day of .

Affiant exhibiting to me his/her Residence Certificate No. issued at
on _____________________.

Doc. No. :
Page No. :
Book No. :
Series No. :__________
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF KALINGA)S.S

AFFIDAVIT

I, ____________________________________ of legal age, single/marries, Filipino citizen, with postal

address and residence at ______________________________________ after being sworn to in
accordance with law, hereby depose and state the following:

1. That ________________________________is the owner of a parcel of land located at

____________________________________
with an area of ____________sq.m, covered by ____________________________________;

2. That by virtue of a ____________________________________ executed by the owner, I am hereby

given authority to process and subject the above-mentioned property for an application of
Locational Clearance/Certificate of Zoning Certificate for _______________________________;
(Project – Type)

3. That the above - mentioned property(s) was acquired by way of________________ ___________;
(State whether by sale or inheritance, etc.)

4. That the best of my knowledge, the above mentioned property(s) is/are free from any alien or
encumbrance except ____________________________________;
(indicate lien & encumbrance)

5. That the best of my knowledge, the above mentioned property(s) is/are situated within alienable
and disposable lands and outside lands reserve for the public domain and the same is not utilized for
agricultural purposes;

For agricultural Lands only : That the above mentioned property(s) is/are utilized for agricultural
purposes, particularly for the cultivation of .
(Indicated crops)

That I intended to use ___________________ of the property(s) for _______________________;

. (type of crops)

6. That I am executing this affidavit to attest to the veracity of the aboved mentioned facts thereby
satisfying the requirements of the HLURB relative to my application for Locational Clearance/Certificate
of Zoning Compliance for the above mentioned project.

Affidavit further says nothing.

___________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this day of .

Affiant exhibiting to me his/her Residence Certificate No. issued at
on _____________________.

Doc. No. :
Page No. :
Book No. :
Series No. :__________
 Republic of the Philippines
Province of Kalinga
CITY OF TABUK
OFFICE OF THE CITY BUILDING OFFICIAL
APPLICATION FOR BUILDING PERMIT

NEW RENEWAL AMENDATORY

APPLICATION NO. AREA NO. PERMIT NO.

3 8 0 0
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER/APPLICANT LAST FIRST NAME TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE
ADDRESS: NO., STREET BARANGAY, CITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.

STREET: BARANGAY: CITY OF : TABUK

SCOPE OF WORK :
NEW CONSTRUCTION RENOVATION DEMOLITION

ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE

ADDITION REPAIR OTHERS (Specify)

ALTERATION MOVING

USE OR CHARACTER OF OCCUPANCY :

GROUP A: RESIDENTIAL, DWELLINGS GROUP F: INDUSTRIAL OTHERS (Specify)

GROUP B: RESIDENTAIL HOTEL, APARTMENT GROUP G: INDUSTRIAL STORAGE AND HAZARDOUS

GROUP C: EDUCATIONAL, RECREATIONAL GROUP H: RECREATINAL ASSEMBLY OCCUPANT LOAD LESS THAN 1000

GROUP D: INSTITUTIONAL GROUP I: RECREATIONAL ASSEMBLY OCCUPANT LOAD 1000 OR MORE

GROUP E: BUSINESS AND MERCHANTILE GROUP J: AGRICULTURAL ACCESSORY

NUMBER OF STOREY/S : PROPOSED DATE OF CONSTRUCTION :

TOTAL FLOOR AREA: SQ. M. EXPECTED DATE OF COMPLETION :
TOTAL ESTIMATED COST PHP :____________________________
BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)

Address :
PRC No.: Validity:
ARCHITECT OR CIVIL ENGINEER PTR No.: Date Issued:
(Signed and Sealed Over Printed Name) Issued at : TIN:
BOX 3 BOX 4
APPLICANT WITH MY CONSENT : LOT OWNER

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

Address : Address :
CTC No. Date Issued Place Issued : CTC No. Date Issued Place Issued

BOX 5
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF KALINGA ) S.S.
CITY OF TABUK )

BEFORE ME. At the City of ________________________, on ___________________________________ personally appeared at the following:

APPLICANT CTC NO. Date Issued Place Issued

LICENSED ARCHITECT OR CIVIL ENGINEER CTC NO. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)

whose signature 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 this date and place above written.
Doc. No.

Page No. NOTARY PUBLIC

Book No.

Series of
BOX 6 (SUBMITTALS TO BE CHECKED,RECEIVED AND RECORDED)
ASSESSED FESS ASSESSED BY AMOUNT DUE DATE PAID O.R. NUMBER NSO
FILING FEE
ZONING / LOCATIONAL CLEARANCE
EXCAVATION
LINE AND GRADE (GEODETIC)
BUILDING
PLUMBING
ELCTRICAL
MECHANICAL
FIRE FUND FEE
FENCING
OTHERS :

TOTAL
BOX 7 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
BUILDING PERMIT
BUILDING PERMIT NO. OFFICIAL RECEIPT NO.

DATE ISSUED : DATE PAID :

M M D D Y Y M M D D Y Y

Permit is issued to _________________________________ for the proposed _______________________________ under _______________________

( Owner / Applicant ) ( Project ) ( Use or Occupancy )

of group ______, located at lot no. __________ OCT/TCT no. _______________ Barangay _____________________City of Tabuk subject to the follow
1 That under the Article 1723 of the Civil Code of the Philippines, the engineer or architect who drew up the plans and specifications for a building
structure is liable for damages if within fifteen (15) years from the completion of the building / structure, the same should collapse due to defect in
the plans or specifications or defects in the ground. The engineer or architect who supervises the constructions shall be solidatity liable with the
contractor should the edifice collapse due to defect in the construction or the use of interior materials.
2 This permit shall be accompanied by the various applicable ancillary and accessory permits, plans and specifications signed and sealed by the
correspon-ding desing professionals who shall be responsible for the comprehensive and correctness of the plans in compliance to the Code and its
IRR and to all applicable referral codes and professionals regulatory laws.
3 That the proposed construction/erection/addition/alteration/renovation/convertion/repair/moving/demolition, etc. shall be in conformity with the
provisions of the National Building Code, and IRR.
a. That prior to commencement of the proposed projects and construction an actual relocation survey shall be conducted by a duly licensed
Geodetic Engineer
b. That before commencing the excavation the person making or causing the excavation is to be made shall notify in writing the owner of adjoining
property not less than ten(10) days before such excavation is to be made and show how the adjoining property shoul be protected.
c. That no person shall be use or occupy a street, alley or public sidewalk for the performance of work covered by a building permit.
d. That no person shall perform any work or any building or structure adjacent to a public way in general use for pedestrian travel, unless the
pedestrians are protected.
e. That the supervising Architect / Civil Engineer shall keep at the jobsite at all times a logbook of daily construction activities wherein the actual
daily progress of construction including tests conducted, weather condition and other pertinent data are to be recorded, same shall be made
available for scrutiny and comments by the OBO representative during the conduct of his/her inspection pursuant to Section 207 of the National
Building Code
f. That upon completion of the construction, the said lisensed supervising Architect or Civil Engineer shall submit the logbook to the Building
Official duly signed and sealed logbook, as-built plans and other documents and shall also prepare and submit a Certificate of Completion of
the project stating that the construction of the building / structure conform to the provisions of the Code ,its IRR as well as the plans and
ifi changes,
g. All such t modifications and alterations shall likewise be submitted to the Building Official and the subsequent amendatory permit
therefore issued before any work on said changes, modifications and alterations shall be started. The as-built plans and specifications maybe
just an orderly and comprehensive of all documetns which include the originally submitted plans and specifications of all amendments thereto
as actually built or they may be an entirely new set of plans and specifications accurately describing and/or reflecting therein the building as
actually built.
4 That no building structure shall be used until the Building Official has issued a Certificate of Occupancy therefore as provided in the Code. However,
a parital Certificate of Occupancy may be issued for the Use / Occupancy of a portion or portions of a building / structure prior to the completion of
the entire building / structure.
5 That this permit shall not serve as an exemption from securing written clearances from various government authorities exercising regulatory
function affecting building / structures.
6 When the construction is undertaken by contract the work shall be done by a duly licensed and registered contractor pursuant to the provisions of
the Contractor's License Law ( RA 4566 )
7 The owner / Permittee shall submit a duly accomplished prescribed "NOTICE OF CONSTRUCTION" to the Office of the Building Official prior to any
construction activity.
8 The owner / Permittee shall put a Building Permit SIGN / BILLBOARD which complies with the prescribed dimensions and information, which shall
remain posted on the construction site for the duration of the construction.

PERMIT ISSUED BY :
RUBYPETER A. ALBERT
BUILDING OFFICIAL
(Signature Over Printed Name)
Date :____________________
 Republic of the Philippines
Province of Kalinga
City of Tabuk

CITY BUILDING AND ARCHITECTURE OFFICE

CIVIL/STRUCTURAL PERMIT

APPLICATION NO. C/SP NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT: LAST NAME FIRST M.I TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE

ADDRESS: NO. STREET CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.

STREET BARANGAY CITY/MUNICIPALITY

SCOPE OF WORK:

NEW CONSTRUCTION RENOVATION RAISING

ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BLDG/STRUCTURE
ALTERATION MOVING OTHERS(Specify)

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF CIVIL/STRUCTURAL WORKS:

STAKING ERECTION/LIFTING PRESTRESS WORKS

EXCAVATION CONCRETE FRAMING MATERIAL TESTING
SOIL STABILIZATION STRUCTURAL STEEL FRAMING STEEL TOWERS
PILING WORKS SLABS TANKS
FOUNDATION WALLS OTHERS(Specify)

PREPARED BY:

BOX 3 BOX 4
DESIGN PROFESSIONAL,PLANS AND SPECIFICATIONS SUPERVISOR/IN-CHARGE OF CIVIL/STRUCTURAL WORKS

CIVIL/STRUCTURAL ENGINEER CIVIL/STRUCTURAL ENGINEER

(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)

Date: Date:

Address: Validity Address: Validity

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

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

Date: Date:
Address Address
C.T.C No. Date Issued Place Issued C.T.C No. Date Issued Place Issued
BOX 7( TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:

FIVE(5) SETS OF CIVIL/STRUCTURAL DOCUMENTS

CIVIL/STRUCTURAL DESIGNS, COMPUTATIONS. COST ESTIMATES

PLANS AND SPECIFICATIONS
OTHERS(Specify)
BILL OF MATERIALS

BOX 8
PROGRESS FLOW
IN OUT PROCESSED BY
DATE TIME DATE TIME
CIVIL STRUCTURAL
OTHERS(Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED TO THE FOLLOWING:

1 That under article 1723 of the Civil Code of the Philippines, the engineer(or architect) who drew up the plans
an specifications for the building/structure is responsible for damges if within fifteen(15) years from the completion
of the building/structure, the same should collaps due to defect in the plans or specifications of defects in the ground
The engineer or architect who supervises the construction shall be liable with the contractor should the edifice
collapse due to defect in the construction or the use of interior matrials.

2 That the proposed civil/structural works shall be in accordance with the civil/structural plans filed with this office
and in corfomity with the latest national Structural Code of the philippines, the National Building Code and its IRR.

3 That prior to any construction activity, a duly accomplished prescribed " Notice of Construction" shall be submitted
to the Office of the Building Official.

4 That upon completion of the construction, the licensed full-time inspector and supervisor/in-chargeof construction
works shall submit the entry to the logbook duly signed and sealed to the Building official including as-built plans and
other documents and shall accomplish and submit a certificate of completion that the civil/structural works conform
to the provision of the National Building Code and its IRR.

5 That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

RUBYPETER A. ALBERT
BUILDING OFFICIAL
(Signature Over Printed Name)

Date:
 Republic of the Philippines
Province of Kalinga
Municipality of Tabuk
OFFICE OF THE BUILDING OFFICIAL

SANITARY/PLUMBING PERMIT
APPLICATION NO. PERMIT NO.

DATE OF APPLICATION DATE ISSUED

BOX 1(TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT)
NAME OF OWNER/APPLICANT LAST NAME FIRST NAME M.I TAX ACCT. NO.

ADRRESS
LOCATION OF INSTALLATION NO. STREET, BARANGAY, CITY/MUNICIPALITY

USE OR TYPE OF OCCUPANCY

RESIDENTIAL AGRICULTURAL
COMMERCIAL PARKS,PLAZAS,MONUMENTS
INDUSTRIAL RECREATIONAL
INSTITUTIONAL OTHERS(SPECIFY)
FIXTURES TO BE INSTALLED
NEW EXISTING KIND OF NEW EXISTING KIND OF
QTY FIXTURES FIXTURES FIXTURES QTY FIXTURES FIXTURES FIXTURES
Water Closet Bidette
Floor Drain Laundry Trays
Lavatories Dental Cuspidor
Kitchen Sink Gas Heater
Faucet Electric Heater
Shower Head Water Broiler
Water Meter Drinking Fountain
Grease Strap Bar Sink
Bath Tub Soda Fountain Sink
Slop Sink Laboratory Sink
Urinal Sterilizer
Air Conditioning Unit Swimming Pool
Water tank/Reservoir Others(Specify)
TOTAL
WATER DISTRIBUTION SYSTEM SANITARY SEWER SYSTEM STORM DRAINAGE SYSTEM
WATER SUPPLY: SYSTEM OF DISPOSAL:
WASTE WATER TREATMENT PLANT SURFACE DRAINAGE
SHALLOW WELL SEPTIC VAULT/IMOFF TANK STREET CANAL
DEEPWELL & PUMP SET SANITARY SEWER CONNECTION WATER COURSE
CITY/MUNICIPAL WATER SYSTEM SUB-SURFACE SAND FILTER
OTHERS
NUMBER OF STOREYS OF BUILDING TOTAL AREA OF BUILDING/SUBDIVISION
PROPOSED DATE TOTAL COST OF INSTALLATION
START OF INSTALLATION PREPARED BY
EXPECTED DATE OF COMPLETION
BOX 2(TO BE ACCOMPLISHED BY BUILDING OFFICIAL)
ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO INSTALL THE SANITARY/PLIMBING
FIXTURES ENUMERATED HEREIN SUBJECT TO THE FOLLOWING
CONDITIONS:
1. That the proposed installation shall be in accordance with the approved
plans files with this office and in conformity.
2. That a duly licensed sanitary engineer/master plumber be engaged to BUILDING OFFICIAL
to undertake the installation/construction.
3. That a certificate of completion duly signed by the sanitary engineer/
master plumber-in-charge of installation shall be submitted not later DATE
than seven(7) days after the completion of the installation.
4. That a certificate of final inspection and Certificate of Occupancy
be secured prior to the actual occupancy of the building.
BOX 3(TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)
BUILDING DOCUMENTS

SANITARY/PLUMBING PLANS & SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS(Specify)

BOX 4(TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

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

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

PROGRESS FLOW
NOTED: IN OUT
TIME DATE TIME DATE
CHIEF,PROCESSING DIVISION/SECTION ACTION/REMARK PROCESSED BY
RECEIVING AND RECORDING
GEODETIC (LINE and GRADE)

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SET FORTH.

BOX 6 BOX 8
SANITARY ENGINEER PRC REG. NO. SIGNATURE
SIGNED AND SEALED PLANS & SPECIFICATIONS
APPLICANT
PRINT NAME Com. Tax cert. Date Issued Place Issued

ADDRESS

PTR NO. DATE ISSUED PLACE ISSUED

SIGNATURE TIN

BOX 7
SANITARY ENGINEER/MASTER PLUMBERS PRC REG. NO.
IN-CHARGE OF CONSTRUCTION/ONSTALLATION

PRINT NAME

ADDRESS

PTR NO. DATE ISSUED PLACE ISSUED

SIGNATURE TIN
 Republic of the Philippines
Province of Kalinga
City of Tabuk

CITY BUILDING AND ARCHITECTURE OFFICE

ARCHITECTURAL PERMIT

APPLICATION NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT: LAST NAME FIRST M.I TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE

ADDRESS: NO. STREET CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.

STREET BARANGAY CITY/MUNICIPALITY

SCOPE OF WORK:

NEW CONSTRUCTION RENOVATION RAISING

ERECTION CONVERSION ACCESSORY BLDG/STRUCTURE
ADDITION REPAIR OTHERS(Specify)
ALTERATION MOVING

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

1. ARCHITECTURAL FACILITIES AND OTHER FEATURES PURSUANT TO BATAS PAMBANSA BILANG 344, REQUIRING CERTAIN
BUILDINGS, INSTITUTIONAL ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES.
Stairs Wash rooms 7 toilets Switches Controls,buzzers Drinking Fountains
Walkways Lifts/elevators Handrails Public Telephones
Corridors Ramps Thresholds Seating Accomodations
Doors, entrances & thresholds Parking Areas Floor Finish Others(Specify)
2. PERCENTAGE OF SITE OCCUPANCY 3. Conformance to the FIRE CODE OF THE PHILIPPINES (P.D 1185)
Percentage of Building Footprints % No. & Width of Exit Doors Fire Walls Others(Specify)
Percentage of Impervios Surface Area % Width of Corridors Fire Fighting and Safety Facilities
Percentage of Unpaved Surface Area % Distance to Fire Exits Smoke Detectors
Other (specify) Access to Public Street Emergency Lights
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR/IN-CHARGE OF ARCHITECTURAL WORKS

Date Date
ARCHITECT ARCHITECT
(Sign & Sealed Over Printed Name) (Sign and Sealed Over Printed Name)
Address Address
PRC No. VALIDITY PRC No. VALIDITY
IAPOA No. O.R No. Date Issued IAPOA No. O.R No. Date Issued
PTR No. Place Issued Date Issued PTR No. Place Issued Date Issued
TIN TIN
BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

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

Date Date
Address Address
C.TC. No. Date Issued Place Issued C.TC No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7
RECEIVED BY
FIVE(5) SETS OF ARCHITECTURAL DOCUMENTS

1 Vicinity Map/Location Plan within a two 8 Details of Ramps, Parking for the disabled, Stairs, fire
Kilometers radius Escapes, cabinet and Partitions.
2 Site Development Plan 9 Schedule of Doors and Windows
3 Perspective 10 Schedule of Finishes for Floors, Ceilings and Walls
4 Floor Plans 11 Architectural interior
5 Elevations at Least Four(4) 12 Specifications
6 Sections at Least two(2) 13 Cost Estimate
7 Ceiling Plans showing Lighting Fixtures 14 Others (specify)
and diffusers
BOX 8
PROGRESS FLOW
IN OUT
DATE TIME DATE TIME PROCESSED BY:
ARCHITECTURAL DRAWING
SPECIFICATIONS
OTHERS(Specify)

BOX 9
ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

That Under article 1723 of the Civil Code of the Philippines, the ARCHITECT (and engineer) who drew up the plans and
specifications for the building/structure is responsible for damages if within fifteen(15) years from the completion of the
building/structure, the same should collapse due to defect in the plans or specificatios or defects in the ground. The
Engineer or Architect who supervises the construction shall be solidarily liable with the contract should the edifice
collapse due to defect in the construction or the use of interior materials.

That the proposed architectural works shall be in accordance with the architectural plans field with this office and
in conformity with the latest Architectural Code of the Philippines, the National Building Code and its IRR.

That prior to any construction activity, a duly accomplished prescribed " Notice to Construction' shall be submitted
to the office of the Building official.

That upon completion of the construction, the licensed full-time inspector and supervisor/in-charge of construction
works shall submit the entry to the logbook duly signed and sealed to the building official including as built plans
and other provision of the Architectural Code, the National Building code and its IRR.

That this permit is Null and Void unless accompanied by the BUILDING PERMIT.

APPROVED:

VLADIMIR MALAGA
ARCHITECT DATE
PRC #: IAPOA

NOTED:

RUBYPETER A.ALBERT
BUILDING OFFICIAL DATE
(Signature Over Printed Name)
 Republic of the Philippines
Province of Kalinga
City of Tabuk
CITY BUILDING AND ARCHITECTURE OFFICE

APPLICATION FOR ELECTRICAL PERMIT

APPLICATION NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT: LAST NAME FIRST M.I TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE

ADDRESS: NO. STREET CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.

STREET BARANGAY CITY/MUNICIPALITY

SCOPE OF WORK:
NEW INSTALLATION RECONNECTION OFSERVICE ENTRANCE RELOC. 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 CAPACITY

KVA KVA KVA

BOX 2 ( TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

DESIGN PROFESSIONAL,PLANS AND SPECIFICATIONS
Address Validity
Date: PRC NO. Date Issued
Professional Elect. Engineer PTR NO. TIN
(signature & seal over printed name) Issued at

BOX 3
SUPERVISOR/IN-CHARGE OF ELECTRICAL WORKS

PROFESSIONAL ELECTRICAL ENGR. REGISTERED ELECTRICAL ENGR. REGISTERED MASTER ELECTRICIAN

Date:
(Signed & 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

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

Date Date

Address Address
C.T.C No. Date Issued Placed Issued C.T.C No. Date Issued Placed Issued
 Province of Kalinga
City of Tabuk

CITY BUILDING AND ARCHITECTURE OFFICE

ELECTRICAL PERMIT

PERMIT NO. APPLICATION NO.

DATE ISSUED : DATE FILED :

PAID UNDER O.R N :
AMOUNT:
DATE:

BOX 1
NAME OF OWNER/APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

ADDRESS: NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.

LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY

BOX 2
ASSESSED FEES
AMOUNT ASSESSED BY: O.R NUMBER DATE PAID

BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICE AND EQUIPMENT IN THE APPLICATION SUBJECT
TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE
AND IN CONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE.

2. THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE IN-CHARGE OF THE INSTALLATION/CONSTRUCTION.

3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY THE ELECTRICAL PRACTITIONER IN-CHARGE OF THE
INSTALLATION BE SUBMITTED NOT LATER THAN (7) DAYS AFTER COMPLETION OF THE WORK.

4. THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF
THE BUILDING.

5. THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.

APPROVED:

EDWARD J. BARCELLANO
ELECTRICAL ENGINEER/OF THE BUILDING OFFICE DATE
PRC REG. NO. & VALIDITY 003636

NOTED:

RUBYPETER A. ALBERT
BUILDING OFFICIAL DATE

NOTE 1: THIS PERMIT MAY BE CANCELLED OR REVOKED PERSUANT TO SECTION 105 & 306 OF THE NATIONAL BUILDING
CODE.
NOTE 2: ALTERATIONS ON THIS FORM IS NOT ALLOWED.
 Republic of the Philippines
Province of Kalinga
City of Tabuk

APPLICATION FOR MECHANICAL PERMIT

APPLICATION NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT: LAST NAME FIRST M.I TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE

ADDRESS: NO. STREET CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.

STREET BARANGAY CITY/MUNICIPALITY

SCOPE OF WORK:
ADDITION OF ________ BUILDING PERMIT NO. ____________
NEW INSTALLATION REMOVAL OF ________ CERTIFICATE OF OCCUPANCY NO:
OTHERS (SPECIFY) ________ ______________________________

SUMMARY OF MECHANICAL LOADS/CAPACITIES APPLIED FOR

TOTAL INSTALLED LOAD TOTAL CAPACITY TOTAL GENERATION CAPACITY

TONS TONS TONS

BOX 2 ( TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

DESIGN PROFESSIONAL,PLANS AND SPECIFICATIONS
Address Validity
Date: PRC NO. Date Issued
Professional Elect. Engineer PTR NO. TIN
(signature & sealed over printed name) Issued at

BOX 3
SUPERVISOR/IN-CHARGE OF LECTRICAL WORKS

PROFESSIONAL MECHANICAL ENGR.

Date:

PRC NO. Validity

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

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

Date Date

Address Address
 City of Tabuk

CITY BUILDING AND ARCHITECTURE OFFICE

MECHANICAL PERMIT
DATE ISSUED : DATE FILED :
PAID UNDER O.R N :
AMOUNT:
DATE:
BOX 1
NAME OF OWNER/APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

ADDRESS: NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.

LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY

SCOPE OF WORK ADDITION OF ________ BUILDING PERMIT NO. ____________

NEW INSTALLATION REMOVAL OF ________ CERTIFICATE OF OCCUPANCY NO:
OTHERS (SPECIFY) ________ ______________________________
USE OR TYPE OF OCCUPANCY
RESIDENTIAL AGRICULTURAL
COMMERCIAL LANDSCAPING
INDUSTRIAL OTHERS (SPECIFY)
INSTITUTIONAL
INSTALLATION AND OPERATION OF
BOILER CENTRAL AC UNIT DUMBWAITER
PRESSURE VESSELS MECHANICAL VENTILATION PLUMPS
INTERNAL COMBUSTION ENGINE ESCALATOR COMPRESSED AIR, VACCUM
REFRIGERATION & ICE MAKING MOVING SIDEWALK INSTITUTIONAL AND
WINDOW TYPE AC UNIT FREIGHT ELEVATOR INDUSTRIAL GAS
PACKAGE TYPE AC UNIT PASSENGER ELEVATOR PNEUMATIC TUBES
CONVEYORS. MONORAILS
OTHERS (SPECIFY) _____________________________________________________________________________
PROPOSED DATE OF EXPECTED DATE OF
INSTALLATION_______________________________ COMPLETION ___________________________________
TOTAL INSTALLATION COST ___________________ PREPARED BY __________________________________
BOX 2
ASSESSED FEES
AMOUNT ASSESSED BY: O.R NUMBER DATE PAID

Reviewed By:

(Chief,Processing Div/Sec)

BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE MECHANICAL EQUIPMENT ENUMERATED HEREIN SUBJECT
TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE
AND IN CONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE NATIONAL BUILDING CODE
2. THAT A DULY LICENSED MECHANICAL ENGINEER BE IN-CHARGE OF THE INSTALLATION/CONSTRUCTION.
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A PROFESSIONAL MECHANICAL ENGINEER IN-CHARGE
OF THE INSTALLATION BE SUBMITTED NOT LATER THAN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
4. THAT A CERTIFICATE OF FINAL INSPECTION BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF
THE BUILDING.
5. THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.
APPROVED:

MECHANICAL ENGINEER OF THE BUILDING OFFICE DATE

PRC REG. NO. & VALIDITY
NOTED:
RUBYPETER A. ALBERT
BUILDING OFFICIAL DATE
NOTE 1: THIS PERMIT MAY BE CANCELLED OR REVOKED PERSUANT TO SECTION 105 & 306 OF THE NATIONAL BUILDING CODE
NOTE 2: ALTERATIONS ON THIS FORM IS NOT ALLOWED.
 Republic of the Philippines
Province of Kalinga
City of Tabuk
OFFICE OF THE BUILDING OFFICIAL

EXCAVATION AND GROUND PREPARATION PERMIT

APPLICATION NO. PERMIT NO.

DATE OF APPLICATION DATE ISSUED

Permit is hereby granted to

for the excavation and ground preparation of his/her site located at
for the construction of his/her proposed
building/structure for which a Building
Permit has been applied for in this Office, subject to the following conditions:

1. All public facilities and utilities such as streets, sidewalks, curbs, gutters, electric posts, power and
communication lines, water, sewer and drainage lines and the like shall be properly protected against
any damage and obstruction. Any facility and/or utility damaged shall be properly repaired and restored
to its original condition by the owner/applicant subject to the approval of the Building Official and the
proper authorities concerned.

2. The owner and the contractor shall be jointly responsible for the safety, protection, security and the
convenience of the general public and his/her personnel, third parties, and the works, equipment,
installation and the like. All wastes or discarded materials from the projects shall be properly stored and
disposed of. Water wastes shall be dischaged directly into the drainage lines. Pertinent provisions of the
national Building Code (P.D. 1096) shall be complied with.

Verified as to the following requirements:

__________________ ______________________ _________________________

Land Use and Zoning Line and Grade Court, Yard, Parking Space

Engr. RubyPeter A. Albert

Building Official
 Republic of the Philippines
Province of Kalinga
City of Tabuk
OFFICE OF THE BUILDING OFFICIAL

SCAFFOLDING PERMIT

APPLICATION NO. SP NO. BUILDING PERMIT NO.

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

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

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS NO. STREET, BARANGGAY, CITY/MUNICIPALITY ZIP CODE TEL.NO.

LOCATION OF CONSTRUCTION: LOT NO.___________ BLK NO.__________ TCT NO._________ TAX DEC.NO.__________
STREET _______________BARANGGAY________________CITY/MUNICIPALITY OF_____________

SCOPE OF WORK:
NEW CONSTRUCTION RENOVATION____________ RAISING________________
ERECTION CONVERSION___________ DEMOLITION
ADDITION REPAIR_________________ ACCESORY BUILDING/STRUCTURE
ALTERATION MOVING________________ OTHERS (Specify)

BOX 2 BOX 3
DESIGN PROFESSIONAL,PLANS AND SPECIFICATION FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS

DATE DATE
ARCHITECT OR CIVIL ENGINEER ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)

Address Address
PRC NO. Validity PRC NO. Validity
PTR NO. Date Issued PTR NO. Date Issued
Issued At TIN Issued At TIN
BOX 4 BOX 5
BUILDING OWNER WITH MY CONSENT : LOT OWNER

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

Date Date

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

BOX 6

APPLICANT
(Signature Over Printed Name)
Date

CCT NO. DATE ISSUED PLACE ISSUED

TIN

BOX 7 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION))

FREE PAID OFFICIAL RECEIPT NO.

DATE PAID DATE ISSUED
BOX 8 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:

Permit is hereby issued/granted to

with postal address at
to erect a SCAFFOLDING for
with a frontage of ( )lineal meters at the premises of
for the period of ( )days inclusive from ,__ to ,___
pursuant to pertinent provisions of the"National Building Code" (P.D 1096) and its implementing Rules and Regulations and
to the following conditions:
1 That the owner and contractor shall be jointly responsible for the safety,protection, security and convenience of
the general public and his/her personnel,third parties,the works,equipment and the like.
2 That the scaffolding shall not be erected on the roadway area nor shall it obstruct the free passage of
pedestrians.
3 That surface drains and other utility fixtures or lines shall not be obstructed.
4 That this permit shall not serve as exemption from securing permits/written clearances from various
government authorities exercising regulatory function affecting buildings and other related structures.

PERMIT ISSUED BY:

RUBY PETER A. ALBERT

BUILDING OFFICIAL
(Signature Over Printed Name)

Date
 Republic of the Philippines
Province of Kalinga
Tabuk City

OFFICE OF THE BUILDING OFFICIAL

APPLICATION FOR CERTIFICATE OF OCCUPANCY

FULL PARTIAL

Building Permit No :
Date Issued :

Name of Owner / Applicant :

(Last Name) (Given name) (M.I.)

Addres of Owner / Applicant : ZIP CODE :

Tel . No.

Requirement Submitted

As-Built Plans and Specifications, duly signed and sealed by Others : (Specify)
Perspective professional discipline
Daily Construction Works Logbook
Certificate of Completion, duly notarized

Name of Project :
Location :
(lot No.) (Blk.No.)(Street) (Barangay) (City/Municipality)

Use / Character of Occupancy :

No. of Storey :
No. of Unit/s :
Total Floor Area (square meters) :
Date of Completion :

Submitted by :

OWNER/APPLICANT
(Printed Over Printed Name)
Community Tax Certificate No. :
Date Issued :
Place Issued :