FM-LBOD-03 / Revision 03 / 05-04-2015 FM-LBOD-03 / Revision 03 / 05-04-2015

Republic of the Philippines Republic of the Philippines

Province of Pampanga Province of Pampanga
City of San Fernando City of San Fernando

OFFICE OF THE BUILDING OFFICIAL OFFICE OF THE BUILDING OFFICIAL

TO : THE REGIONAL DIRECTOR TO : THE REGIONAL DIRECTOR

DOLE-Regional Office III DOLE-Regional Office III
City of San Fernando, Pampanga City of San Fernando, Pampanga

SUBJECT : ENDORSEMENT OF BUILDING PERMIT APPLICATION FOR SUBJECT : ENDORSEMENT OF BUILDING PERMIT APPLICATION FOR
CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)

Pursuant to the provisions of the Joint Administrative Order No.
01 series of 2011 and DILG Memorandum Circular 2012-052 dated March
12, 2012, this office respectfully endorse herein sets of plans and
specifications for your evaluation, review and/or recommendation/s of
building permit application for Construction Safety and Health Program.
Pursuant to the provisions of the Joint Administrative Order No.
01 series of 2011 and DILG Memorandum Circular 2012-052 dated March
12, 2012, this office respectfully endorse herein sets of plans and
specifications for your evaluation, review and/or recommendation/s of
building permit application for Construction Safety and Health Program.

Name of owner/applicant _______________________________________ Name of owner/applicant _______________________________________

Proposed project ______________________________________________ Proposed project ______________________________________________
Location of construction _________________________________________ Location of construction _________________________________________

Thank you. Thank you.

ENGR. EFREN M. DE LEON ENGR. EFREN M. DE LEON

Building Official Building Official

Received by DOLE: __________ Received by DOLE: __________

Date received: _____________ Date received: _____________

ISO 9001:2008 CERTIFIED PROCESSES ISO 9001:2008 CERTIFIED PROCESSES

CERT. NO. CIP/3642/05/09/424 CERT. NO. CIP/3642/05/09/424