REPUBLIC OF THE PHILIPPINES DPWH FORM NO.

77-004
004-B
PROVINCE OF PAMPANGA Revision No. 00
CITY OF SAN FERNANDO
OFFICE OF THE BUILDING OFFICIAL

CERTIFICATE OF COMPLETION

THIS IS TO CERTIFY THAT THE CONSTRUCTION OF THE BUILDING COVERED BY BUILDING PERMIT NO.
______________________ ISSUED ON __________________ HAS BEEN COMPLETED IN ACCORDANCE WITH THE
APPROVED PLANS AND SPECIFICATIONS ON FILE WITH THIS OFFICE OF THE BUILDING OFFICIAL AND THE
“NATIONAL BUILDING CODE (P.D. 1096).”

THAT THE SAIDID BUILDING AND/OR STRUCTURE IS READY FOR FINAL INSPECTION FOR THE ISSUANCE OF
THE “CERTIFICATE OF OCCUPANCY.”

NAME OF OWNER _________________________________________________________________

LOCATION OF CONSTRUCTION _____________________________________________________
USE OR TYPE OF OCCUPANCY _____________________________________________________
DATE OF START OF CONSTRUCTION:
PROPOSED ____________________________ ACTUAL ____________________________
DATE OF COMPLETION:
EXPECTED _____________________________ ACTUAL ____________________________
TOTAL FLOOR AREA (sq. meter)
ESTIMATED ____________________________ ACTUAL ____________________________
NO. OF STOREYS _______________________ ACTUAL HEIGHT ____________________
ESTIMATED COST P _____________________
ACTUAL COST P ________________________ (FOR STATISTICAL PURPOSE ONLY)

A. Materials (total cost) P __________________________

1. Cement (bags)
2. Lumber
3. Reinforcing bars (kg.)
4. No. of G.I. sheets
5. Pre-fab
fab structural steel (kg.)
B. Direct Labor (total cost) P _______________________
This include compensation whether by salary on contract
Architect/Engineer down to laborers.
C. Rental Equipment if any P _______________________
D. Other cost P __________________________________
This includes
s professional service fee, permits and other fees.

IF CONSTRUCTION IS UNDERTAKEN BY CONTR

RACT

____________________________ ____________________________
ARCHITECT/CIVIL ENGINEER SANITARY ENGINEER ______________________
IN-CHARGE
CHARGE OF CONSTRUCTION IN-CHARGE OF INSTALLATION CONTRACTOR

PRC REG. NO. _________________________ CONFORME:

CLASS ________________________________
TIN ___________________________________
RES. CERT. ____________________________ _________________________
ADDRESS _____________________________ OWNER/APPLICANT

http://www.cityofsanfernando.gov.ph