C2021-1
Republic of the Philippines
City of Cebu
CITY PLANNING AND DEVELOPMENT OFFICE
A. LOCATIONAL CLEARANCE APPLICATION FORM
CELLSITE
NAME OF OWNER OR CORPORATION: ___________________________________________________________________________________________
ADDRESS OF OWNER OR CORPORATION: ________________________________________ CONTACT No. of OWNER_________________________
REPRESENTATIVE OF THE OWNER WILL PROCESS OWNER WILL PROCESS LC
NAME OF PERSON PROCESSING THE APPLICATION: _______________________
CONTACT No. OF REPRESENTATIVE: _______________
SPA for the person authorized to process the application of the individual owner
Secretary Certificate or Board Resolution (for Corporation) for the person authorized to process the permit application
TYPE OF APPLICATION: ______________________________________________ NEW REPAIR
PROJECT TITLE: ______________________________________________________________ STARTED NOT STARTED
LOCATION OF THE PROJECT: ____________________________________________________________ BARANGAY: ___________________________
OWNS THE LOT DOES NOT OWN THE LOT LEASED THE LOT
PROJECT LIFESPAN:__________________________________ PERMANENT TEMPORARY
A. GENERAL REQUIRED DOCUMENTS (1 ORIGINAL COPY, 1 CERTIFIED TRUE COPY) NO. OF COPIES DO NOT FILL UP. CPDO USE ONLY
1. Written certification under oath executed by the responsible officer of the company that there is no
other available or suitable site within the coverage area except the subject property inside the 2
subdivision project and said location will best serve the purpose of interconnectivity effectively AND
2. an Affidavit of Undertaking that they will conduct social preparation among the affected
2
homeowners, households, or families AND
3. Height Clearance from Civil Aviation Authority of the Philippines (CAAP) 2
4. Photocopy of the Designer's PRC ID with 3 sample signature specimen 2
NO. OF
B. LOT DOCUMENTS (1 ORIGINAL COPY, 1 CERTIFIED TRUE COPY*)
COPIES
1. Lot Title (*Certified True Copy from Register of Deeds) 2
2. Lot Tax Declaration (Current Year, *Certified True Copy from City Assessor’s Office) 2
- Deed of Absolute Sale (if name in the TCT and Tax Declaration is not yet the new owner / applicant)
2
OR
- Consent and Authority to use the land (if applicant is not the Lot Owner) OR 2
- Secretary’s Certificate/Board Resolution to use the land (if owned by Corporation) OR 2
- Notarized Contract of Lease (IF PROPERTY IS LEASED BY THE APPLICANT) 2
C. PLANS
1. Vicinity Map / Location Plan (Specified Landmarks) {LOCATION OF THE BUILDING} 2
2. Specifications, Bill of Materials (Duly signed by a Licensed Professional) 2
3. All sheets must have COMPLETE and CORRECT informations in title blocks (Details of the Designer (such as PRC
No.,IAPOA No., PTR No., Tin No.), Signed and Sealed, Project Location and Title Signed by Owner)
IMPORTANT: THE APPROVAL OF YOUR LOCATIONAL CLEARANCE IS BASED ON THE PLANS AND DOCUMENTS YOU HAVE SUBMITTED TO THE CITY
PLANNING AND DEVELOPMENT OFFICE. ANY DEVIATION FROM THE PLANS SUBMITTED WILL NOT PREJUDICE THE OFFICE OF THE BUILDING OFFICIAL
(OBO), WHO WILL DIRECT YOU TO DEMOLISH ANY STRUCTURE THAT DOES NOT FOLLOW THE APPROVED LOCATIONAL CLEARANCE.
SIGNATURE OF APPLICANT TIN NO. OF OWNER SIGNATURE OF AUTHORIZED REPRESENTATIVE
SUBSCRIBED AND SWORN TO before me this __________ day of __________________ In the City of Cebu, Affiant exhibited to me his / her
Community Tax Certificate No. ______________________________ issued at _____________________ on ____________________________
__________________________________________
NOTARY PUBLIC
Doc. No.: _____________________
Page No.: _____________________
Book No. : _____________________
Series of No.: _____________________
DO NOT FILL UP BELOW. FOR CPDO RECEIVING SECTION ONLY
RECEIVED BY: ____________________________________________________ DATE RECEIVED: ________________TRN____________________
CELLSITE APPLICATION FORM
CCG-CCPDO