Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Regional Office 6
Antique Provincial Office
San Jose Fire Station
T. A. Fornier St., San Jose de Buenavista, Antique
(036) 540-7175 / 0915-324-8833
sanjose_fire@yahoo.com.ph)
FSCHWO NO. R06-0001 OCTOBER 11, 2019
DATE
FIRE SAFETY CLEARANCE
HOT WORKS OPERATION
TO WHOM IT MAY CONCERN:
By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008 and its Implementing Rules
and Regulations (IRR), this CLEARANCE is hereby issued for Hot Work Operation to, CHOPS CHILDREN’S PARK
(Name of Building/Structure/Facility)
located at 3RD FLR. ROBINSONS PLACE, SAN ANGEL, SAN JOSE ANTIQUE, owned by JLDK CEBU INC.
(Address) (Name of Owner/Representative)
and to be installed by JDLK CEBU INC.ARNAN BINOSA
(Name of Installer/Company)

BEFORE INIATING HOT WORK, ENSURE PRECAUTION ARE IN PLACE!

MAKE SURE AN APPROPRIATE FIRE EXTINGUISHER IS READILY AVAILABLE!
INSTRUCTIONS REQUIRED PRECAUTIONS MEASURE
Verify precautions listed at right (or do not IMPORTANT: SAFETY OFFICER shall be responsible in checking FIRE SAFETY
Proceed with the work). PRECAUTIONARY MEASURE and shall be liable in authorizing hot work despite
Complete and retain this permit the presence of the following conditions:
Available sprinklers, hose streams and extinguishers in
service/operable.
JOB NO Hot work equipment in good repair
REQUIREMENT WITHIN 35FT (10M) OF WORK
NATURE OF JOB/OBJECT Flammable liquids, dust, lint and all deposits removed.
Explosive atmosphere in area eliminated.
Floors swept clean.
RESIZING OF SWIMBALLS AREA Combustible floors wet down, covered with damp sand or fire resistant
sheets.
BUILDING/ESTABLISHMENT AND ADDRESS Remove other combustibles where possible, otherwise protect with fire
resistant tarpaulins or metal shields.
All wall and floor openings covered.
3RD FLOOR ROBINSONS PLACE, ANTIQUE Fire resistant tarpaulins suspended beneath work.
WORK ON WALLS OR CEILINGS/ENCLOSED EQUIPMENT
NAME OF PERSON(S) DOING HOT WORK Construction is non-combustible and without combustible covering
insulation.
Combustible on other side walls moved away.
ARNAN BINOSA Danger exist by conduction of heat into another area
NAME OF PERMIT AUTHORIZING INDIVIDUAL (PAI) Enclosed equipment cleaned of all combustibles.
Containers purged of flammable liquids/vapors
FIRE WATCH/HOT WORK AREA MONITORING
CLEARANCE DURATION: DATE AND TIME Fire watch will be provided during and for 30 minutes after work,
including any coffee or lunch breaks.
OCTOBER 14, 15-16, 2019 08:00PM-07:00AM Fire watch is supplied with suitable extinguishers
NAME OF FIRE WATCH/WATCHMEN Fire watch is trained in use of this equipment and in sounding alarm.
Fire watch may be required for adjoining area, above and below.
Monitor hot work area for 30 minutes after job is completed. Conduct numbers of
RONNIE PEREZ nearest fire station conspicuously displayed in the area
Is area protected with smoke or heat detection.
Ample ventilation to remove smoke/vapor from work area
Violation of Fire Code provisions shall cause this Clearance null and void after appropriate proceeding and shall hold the
contractor liable to the penalties provided for by the said Fire Code.
This certificate is valid until 17/ 10/ 2019
Date Month Year
Fire Code Fees:
Amount Paid 150.00 RECOMMEND APPROVAL:
O.R. Number: 5178726
Date: 10-11-2019

F03 Ramil B Escander

CHIEF, FSES

APPROVED:

SINSP PANCHO B DELA CRUZ

CITY/MUNICIPAL FIRE MARSHAL
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
DISTRIBUTION: MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
Original (Applicant/Owner’s Copy)
Duplicate (BFP Copy) “FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-034 REV.01 (07.05.19)