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Pua - Electronics Form - 1669326769

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Mark Anthony Valbuena
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22 views2 pages

Pua - Electronics Form - 1669326769

Uploaded by

Mark Anthony Valbuena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NBC FORM NO.

A-07
TRACKING NO
137-9Y9NLWFM
Republic of the Philippines
PROVINCE OF ALBAY
CITY OF LEGAZPI

OFFICE OF THE CITY BUILDING OFFICIAL

ELECTRONICS PERMIT
APPLICATION NO. ELP NO. BUILDING PERMIT NO.

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


OWNER/APPLICANT LAST NAME FIRSTNAME M.I. TIN
PUA JHON KENNETH D 410-404-466
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
INDIVIDUAL E301 - ALL PERMITTED USES IN DIVISION E-1(OR
BY AN ENTERPRISE FOR C-1 AND C-2 CLASS) BUILDINGS /

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


30 DON RAMON STREET TALAYAN VILLAGE QUEZON CITY (0917) 880-1072
LOCATION OF CONSTRUCTION: LOT NO. 14 BLK NO. 7 TCT NO. TAX DEC NO.

STREET F. IMPERIAL STREET CORNER BARANGAY CAPANTAWAN CITY/MUNICIPALITY CITY OF LEGAZPI

SCOPE OF WORK

NEW INSTALLATION ANNUAL INSPECTION OTHERS (specify)

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)

NATURE OF INSTALLATION WORKS/EQUIPMENT SYSTEM:


ELECTRONICS COMPUTERIZED
X TELECOMMUNICATION SYSTEM X ELECTRONICS FIRE ALARM SYSTEM PROCESS CONTROLS
SOUND COMMUNICATION SYSTEM AUTOMATION SYSTEM
BROADCASTING SYSTEM
TELEVISION SYSTEM CENTRALIZED CLOCK SYSTEM BUILDING AUTOMATION
MANAGEMENT AND CONTROL
INFORMATION TECHNOLOGY SYSTEM SOUND SYSTEM SYSTEM
SECURITY AND ALARM SYSTEM ELECTRONICS CONTROL AND CONVEYOR
BUILDING WIRING UTILIZING
ANY OTHER ELECTRONICS AND I.T SYSTEMS, COPPER CABLE
EQUIPMENT, APPARATUS, DEVICE AND/OR COMPONENT FIBER OPTIC CABLE OR OTHER
(Specify) MEDIAL ELECTRONICS SYSTEM

PREPARED BY:

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

DENNIS DALE VIANZON JACOB REGINO DAYAP BUITA, JR.


PROFESSIONAL ELECTRONICS ENGINEER PROFESSIONAL ELECTRONICS ENGINEER
(Signed And Sealed Over Printed Name) (Signed And Sealed Over Printed Name)
Date 11/22/2022 Date 11/28/2022
Address Tanjay City,Negros Oriental Address Zone 3, San Vicente, Baao, Camarines Sur
PRC No. 0001181 Validity 05/17/2024 PRC No. 0051501 Validity 03/12/2025
PTR No. 7683958 Date Issued 01/03/2022 PTR No. Date Issued
Issued at VALENZUELA CITY TIN Issued at LEGAZPI CITY TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

JHON KENNETH D. PUA JHON KENNETH D. PUA


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

Address 30 DON RAMON STREET TALAYAN VILLAGE QUEZON Address 30 DON RAMON STREET TALAYAN VILLAGE QUEZON
License No Date Issued Place Issued License No Date Issued Place Issued
N04-06-004779 10/10/2019 QUEZON CITY N04-06-004779 10/10/2019 QUEZON CITY
BOX 7 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

RECEIVED BY: DATE:

FIVE (5) SETS OF ELECTRONICS DOCUMENTS

ELECTRONICS PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify)

BOX 8

PROGRESS FLOW

IN OUT
PROCESSED BY:
DATE TIME DATE TIME

ELECTRONICS

OTHERS (Specify)

BOX 9

ACTION TAKEN

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electronics works shall be in accordance with the electronics plans filed with this Office and in
conformity with the latest Electronics Code of the Philippines, the National Building Code and its IRR.
2. That prior to any electronics installation, a duly accomplished prescribed “Notice of Construction” shall be submitted to the Office of the
Building Official.
3. That upon completion of the electronics works, the licensed supervisor/in-charged 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 the
Certificate of Completion stating that the electronic works conform to the provision of the Electronics Code of the
Philippines, the National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

CITY BUILDING OFFICIAL

(Signature Over Printed Name)


Date

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