HLURB Form

(To be accomplished
in duplicate)

APPLICATION FOR CONVERSION OF _____________________________

BUILDING INTO A RESIDENTIAL CONDOMINIUM

___________________
Date

The Chief Executive Officer

Housing and Land Use Regulatory Board
_____________________________________
_____________________________________

S i r:

In accordance with Sec. 4 of P.D.957 and its implementing

Standards, Rules and Regulation, as amended by Executive Order
No.648 dated 07 February 1981. I am applying for Approval of
Conversion from ___________________ Building into a Residential
Condominium having a total area of _______________ square meters
containing _______________________ units.

The undersigned represents that the plan submitted is in

accordance with the pertinent laws, decrees, rules, regulations,
standards and guidelines and that I assume full responsibility
from any non-compliance or violation thereof. It is likewise
understood that I shall commerce development within one year
upon the issuance of development permit.

Attached hereto are:

1. Four (4) sets of the following duly signed and sealed by

a Licensed Architect/Engineer:

a. Site development Plan

b. Floor Plan
c. 4 Elevations (Front, rear, right side & left side)
d. 2 Sections (cross 7 longitudinal)

2. Certified true copy of Title(s) and Tax Declaration(s)

3. Copy of Building Permit from Local Building Official;

4. Copy of as built plans certified by the Designing

Engineer/Architect;
 5. Written consent/conformity of the tenants for the
proposed change of use or sworn statement that no units
have been leased.

6. Certification from the local Building Official/Municipal

or City Engineer that the structure shall still have a
life span for at least 25 years.

Very truly yours

_______________________
APPLICANT

Address: _______________________
_______________________
Telephone No. _______________________

SUBSCRIBED AND SWORN to before me this ________ day of

__________________, 20_____; Affiant exhibiting his / her
Residence Certificate No. ____________________ issued at
________________ on _____________________.

WITNESS MY HAND AND SEAL.

Doc. No. ____________

Page No. ____________ NOTARY PUBLIC
Book No. ____________
Series of ____________