NBC FORM NO.
A - 02
Republic of the Philippines
Municipality of La Trinidad
Province of Benguet
OFFICE OF THE BUILDING OFFICIAL
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 NAME M.I. TIN
BUYACAO MELODY ANN N.
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, MUNICIPALITY ZIP CODE CONTACT NO./EMAIL ADDRESS
FA 124 Km.5 BALILI LA TRINIDAD 2601
LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.
STREET GAUDAYAN BARANGAY PUGUIS MUNICIPALITY LA TRINIDAD
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BUILDING/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 MARK GREGORY ARO RIMANDO
(Signature Over Printed Name)
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATION SUPERVISOR//IN-CHARGE OF CIVIL/STRUCTURAL WORKS
MARK GREGORY ARO RIMANDO MARK GREGORY ARO RIMANDO
_________________________________________ _________________________________________
CIVIL / STRUCTURAL ENGINEER CIVIL / STRUCTURAL ENGINEER
(Signed and Sealed Over Printed name) (Signed and Sealed Over Printed name)
Date _____________________________ Date _____________________________
Address LA TRINIDAD Address LA TRINIDAD
PRC. No. 0116018 Validity 4/17/2024 PRC. No. 0116018 Validity 4/17/2024
6868047 Date Issued 1/4/2021 6868047
PTR No. PTR No. Date Issued
1/4/2021
Issued at LA TRINIDAD TIN 739-230-657-000 Issued at LA TRINIDAD TIN 739-230-657-000
BOX 5 BOX 6
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
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7
RECEIVED BY: DATE:
FIVE (5) SETS OF CIVIL/STRUCTURAL DOCUMENTS
CIVIL/STRUCTURAL DESIGNS COMPUTATIONS, PLANS AND SPECIFICATIONS COST ESTIMATES
BILL OF MATERIALS OTHERS (Specify)
BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
CIVIL/STRUCTURAL
OTHERS (Specify)
BOX 9
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That under Article 1723 of the Civil Code of the Philippines, the engineer (or architect) 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 specifications or defects in the ground. The
engineer or architect who supervises the construction shall be solidarily liable with the contractor should the edifice collapse
due to defect in the construction or the use of inferior materials.
2. That the proposed civil/structural works shall be in accordance with the civil/structural plans filed with this office and in
conformity 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-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
documents and shall also accomplish and submit a certificate of completion stating that the civil/structural works conform to
the provisions of the National Structural Code of the Philippines, the National Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit.
PERMIT ISSUED BY:
ENGR. BENEDICT P. PINEDA
BUILDING OFFICIAL
Date _________________