Form Reference No: PM-NCR-03.08-F-03.RO1 Regional Office: DOLE-NCR Application No: *” ote ‘Application for CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) Lintended only for residential roject/s (2 storey and below) or minor repair works with 15 workers or lessor with project cost of less than Php3,000,000.00.) Project Name: _feAbvATION) DF _Tem_mEVeAuAYAN Project Complete Address/Location:__LOT 4o Bik 24 GY PER! Mm AR) puch) Project Duration: _ 4 Project Start: ARRIL ©, 2021 _ Completion Date: vie /C, 02) (No. of Calendar days) {Date of estimated start) (Date of project completion) Estimated Project Cost:__492, 054.42 Number of Workers: __/€ Name of Contractor {if any): OLR BUILOERC _DeSIMd_ ARID TA Contractor's Address:_ #389 AguiWO JTREET —_ Cureur: Gul LACAN) FaxNo., PCAB License No__44 304. Date of Validity: Jue 40,.20.2/Email address: ‘Name of Project Owner: _JRAUSCYCLE Fax No.: Project Owner Address: _ LOT 2a _PROY peRer ft AS ww Email address: ‘Accomplished by: ‘Signature over Printed Name of OWNER / CONTRACTOR SAAAASANS ARIA SASHES SANSA EREEAHANSASAROEESERREE OEE EEEKEAEEENOEORREEES ‘COMMITMENT TO COMPLY on OSH We and (Name of Contractor's Authorized Official and/or Project Owner) do hereby commit and bind ourself to comply with the applicable provisions of the Occupational Safety and Health Standards (OSHS) and Department Order No.13 series of 1008 ~ Guidelines Governing Occupational Safety and Health in the Construction Industry. UWe hereby commit to implement a suitable Construction Safety and Health Program designed for the abovementioned project. U/We also acknowledge my/our responsibilities to Provide the appropriate Personal Protective Equipment’ (PPE) and job safety and health instructions and training to all our workers during the duration of the project. fut) de Veen al PROJECT OWNER ‘CONTRACTOR Signature Over Printed Name Signature Over Printed Name (NOTE: NO FEES REQUIRED FOR APPLICATION, PROCESSING AND APPROVAL OF CSHP)