COMPLYING DEVELOPMENT CERTIFICATE APPLICATION Made under the Environmental Planning and Assessment Act 1979 Sections 85, 85A

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COMPLYING DEVELOPMENT CERTIFICATE APPLICATION Made under the Environmental Planning and Assessment Act 1979 Sections 85, 85A IDENTIFICATION OF BUILDING Address Lot, DP/MPS etc Suburb or town Post Code DESCRIPTION OF DEVELOPMENT Detailed Description: APPLICANT Name Company Address Suburb or town Post Code Phone B/H Fax No Mobile Email As the applicant, I/we hereby; 1. Submit this Complying Development Certificate Application under the Environmental Planning & Assessment Act 1979, with Private Certifiers Australia. 2. Appoint of. as the Principal Certifying Authority for the building work identified in this application. Signature of applicant: Sign Date CONSENT TO ALL OWNER(S) Name Company Address Suburb or town Post Code Phone B/H Fax No Mobile Email As the owner of the above property, I/we consent to this application Signature of Owner Sign Date

2 VALUE OF WORK Estimated Cost of work: $ GST: $ For developments over $5 million, a Quantity Surveyors Certificate verifying the cost must be submitted on lodgement of the application. BUILDING CODE OF AUSTRALIA BUILDING CLASSIFICATION Nominated on the Development Consent Class RESIDENTIAL BUILDING WORK Relevant only to residential building work Owner-builder Permit No. or Name of Builder Address Telephone Fax Contractor License No. REQUIRED ATTACHMENTS Note 1 details the information that must be submitted with an application for a complying Development certificate for proposed building works Note 2 details the additional information that may be submitted with an application for a complying Development certificate for proposed residential building work.

3 Schedule 1 information to be Collected for ABS Particulars of the proposal DESCRIPTION What is the area of the land (m 2 ) Gross floor area of existing building (m 2 ) What are the current uses of all or parts of the building(s)/land? (If vacant state vacant) Location Use Does the site contain a dual occupancy? What is the gross floor area of the proposed addition or new building (m 2 ) What are the proposed uses of all parts of the building(s)/land? Location Use Number of pre-existing dwellings Number of dwellings to be demolished How many dwellings are proposed? MATERIALS TO BE USED How many storeys will the building consist of? Walls Code Roof Code Brick veneer 12 Aluminium 70 Full brick 11 Concrete 20 Single brick 11 Concrete tile 10 Concrete block 11 Fibrous cement 30 Concrete/ 20 masonry fibreglass 80 Concrete 20 Masonry/terracott a shingle tiles 10 Steel 60 Slate 20 Fibrous cement 30 Steel 60 Hardiplank 30 Terracotta tile 10 Timber/weatherboard 40 Other 80 Cladding aluminium 70 Unknown 90 Curtain glass 50 Other Unknown 90 Floor Code Frame Code Concrete 20 Timber 40 Timber 10 Steel 60 Other 80 Other 80 Unknown 90 Unknown 90

Schedule 2 Existing Essential Fire Safety Measures Part 1 of 2 Item Existing No. Measure 1 Access Panels, doors and hoppers to fire resisting shaft 2 Automatic fail safe devices 3 Automatic fire detection and alarm system 4 Automatic fire suppression system (sprinkler) 5 Automatic fire suppression system (others specify) 6 Emergency lighting 7 Emergency lifts 8 Emergency warning and intercommunication system 9 Exit signs 10 Fire control centres and rooms 11 Fire dampers 12 Fire doors 13 Fire hydrant systems 14 Fire seals (protecting openings in fire resisting components of the building) 15 Fire shutters 16 Fire windows 17 Hose reel system 18 Light weight construction 19 Mechanical air handling systems 20 Paths of travel stairways passageways or ramps 21 Perimeter vehicle access for emergency vehicles 22 Portable fire extinguishers 23 Pressurising system 24 Required (automatic) exit doors 25 Safety curtains in proscenium openings 26 Smoke and Heat Vents 27 Smoke Control System 28 Smoke dampers 29 Smoke detectors and heat detectors 30 Smoke doors 31 Solid-Core doors 32 Stand-By Power Systems 33 Wall wetting sprinkler and drencher systems 34 Warning and operational signs 35 OTHERS - Specify Is this measure Installed in the Building? Yes / No 4 If yes, enter the current standard of performance (eg: ORD 70 Clause 19.2 or BCA Clause E1.5 & AS 2118.1-1999) This is an accurate statement of all existing Fire Safety Measures implemented in the whole building. Signed... (Owner/ Agent) Name.. Date....

Schedule 3 Proposed Essential Fire Safety Measures Part 2 of 2 Item Proposed New Measure No. 1 Access Panels, doors and hoppers to fire resisting shaft 2 Automatic fail safe devices 3 Automatic fire detection and alarm system 4 Automatic fire suppression system (sprinkler) 5 Automatic fire suppression system (others specify) 6 Emergency lighting 7 Emergency lifts 8 Emergency warning and intercommunication system 9 Exit signs 10 Fire control centres and rooms 11 Fire dampers 12 Fire doors 13 Fire hydrant systems 14 Fire seals (protecting openings in fire resisting components of the building) 15 Fire shutters 16 Fire windows 17 Hose reel system 18 Light weight construction 19 Mechanical air handling systems 20 Paths of travel stairways passageways or ramps 21 Perimeter vehicle access for emergency vehicles 22 Portable fire extinguishers 23 Pressurising system 24 Required (automatic) exit doors 25 Safety curtains in proscenium openings 26 Smoke and Heat Vents 27 Smoke Control System 28 Smoke dampers 29 Smoke detectors and heat detectors 30 Smoke doors 31 Solid-Core doors 32 Stand-By Power Systems 33 Wall wetting sprinkler and drencher systems 34 Warning and operational signs 35 OTHERS - Specify Is this measure Installed in the Building? Yes or No If yes, enter the current standard of performance (eg: BCA Clause E1.5 & AS2118.1-1999) 5 This is an accurate statement of all proposed Fire Safety Measures to be installed/ modified in the whole building. Signed... (Owner/ Agent) Name..... Date

6 Notes for completing Complying Development Certificate Application Note 1 Note 2 Note 3 Note 4 Note 5 In the case of Crown land within the meaning of the Crown Lands Act 1989 the owner s consent must be signed by an officer of the Department of Land and Water Conservation, authorised for these purposes by the Governor-in-Council from time to time. A description of the land to be developed can be given in the form of a map which contains details of the lot number, DP/MPS, vol/fol etc. A plan of the land must indicate: a) Location, boundary dimensions, site area and north point of the land; b) Existing vegetation and trees on the land; c) Location and uses of existing buildings on the land; d) Existing levels of the land in relation to buildings and roads; and e) Location and uses of buildings on sites adjoining the land. Plans or drawings describing the proposed development must indicate (where relevant): a) The location of proposed new buildings or works (including extensions or additions to existing buildings or works) in relation to the land s boundaries and adjoining development; b) Floor plans of proposed buildings showing layout, partitioning, room sizes and intended uses of each part of the building; c) Elevations and sections showing proposed external finishes and heights; d) Proposed finished levels of the land in relation to buildings and roads; e) Building perspectives, where necessary to illustrate the proposed building; f) Proposed parking arrangements, entry and exit points for vehicles, and provision for movement of vehicles within the site, (including dimensions where appropriate); g) Proposed landscaping and treatment of the land, (indicating plant types and their height and maturity; and h) Proposed methods of draining the land. The following information must also accompany a Complying Development Certificate Application for building or subdivision work and change of building use: Building Work In the case of an Application for a Complying Development Certificate for building work: a) Copies of compliance certificates relied upon. b) Four (4) copies of detailed plans and specifications The plan for the building must be drawn to a suitable scale and consist of a general plan and a block plan. The general plan of the building is to: show a plan of each floor section; show a plan of each elevation of the building; show the levels of the lowest floor and of any yard or unbuilt on area belonging to that floor and the levels of the adjacent ground; and indicate the height, design, construction and provision for fire safety and fire resistance (if any). Where the proposed building work involves any alteration or addition to, or rebuilding of, an existing building the general plan is to be coloured or otherwise marked to the satisfaction of the certifying authority to adequately distinguish the proposed alteration, addition or rebuilding. Where the proposed building work involves a modification to previously approved plans and specifications the general plans must be coloured or otherwise marked to the satisfaction of the certifying authority to adequately distinguish the modification. The specification is: to describe the construction and materials of which the building is to be built and the method of drainage, sewerage and water supply; and state whether the materials proposed to be used are new or second hand and give particulars of any second-hand and give particulars of any second-hand materials to be used. c) Where the application involves an alternative solution to meet the performance requirements of the BCA, the application must also be accompanied by: details of the performance requirements that the alternative solution is intended to meet; and details of the assessment methods used to establish compliance with those performance requirements. d) If relevant, evidence of any accredited component, process or design sought to be relied upon.

NB: If an EPI provides that complying development must comply with the deemed-to-satisfy provisions of the BCA a CDC cannot authorise compliance with alternative solutions to the performance requirements corresponding to those deemed-to-satisfy provisions. e) Except in the case of a class 1a or class 10 building: a list of any fire safety measures that are proposed to be implemented in the building or on the land on which the building is situated; and if the application relates to a proposal to carry out any alteration or rebuilding of, or addition to, an existing building, a separate list of such of those measures as are currently implemented in the building or on the land on which the building is situated. The list must describe the extent, capability and basis of design of each of the measures concerned. Change of Building Use In the case of an application for a Complying Development Certificate for a change of building use (except for an application that, if granted, would authorise the building concerned being used as a class 1a or class 10 building): A list of any fire safety measures that are proposed to be implemented in the building or on the land on which the building is situated in connection with the proposed change of building use; and A separate list of such of those measures as are currently implemented in the building or on the land on which the building is situated. The list must describe the extent, capability and basis of design of each of those measures concerned. 7 Note 6 Other information must indicate (where relevant): a) In the case of shops, offices, commercial or industrial development: Details of hours of operation; Plant and machinery to be installed; and Type, size and quantity of goods to be made, stored or transported, loading and unloading facilities. b) In the case of demolition: Details of age and condition of buildings or works to be demolished. c) In the case of advertisements: Details of the size, type, colour, materials and position of the sign board or structure on which the proposed advertisement is to be displayed. d) In the case of development relating to an existing use: Details of the existing use. e) In the case of a development involving the erection of a building, work or demolition: Details of the methods of securing the site during the course of construction. Note 7 Home Building Act Requirements In the case of an application for a complying development certificate for residential building work (within the meaning of the Home Building Act 1989) attach the following: (a) in the case of work by a licensee under that Act: (i) a statement detailing the licensee s name and contractor licence number; and (ii) documentary evidence that the licensee has complied with the applicable requirements of that Act*, or (b) in the case of work done by any other person: (i) a statement detailing the person s name and owner-builder permit number; or (ii) a declaration signed by the owner of the land, to the effect that the reasonable market cost of the labour and materials involved in the work is less than the amount prescribed for the purposes of the definition of owner-builder work in section 29 of that Act. * A certificate purporting to be issued by an approved insurer under Part 6 of the Home Building Act 1989 to the effect that a person is the holder of an insurance contract issued for the purposes of that Part, is sufficient evidence that the person has complied with the requirements of that Part. Note 8 Long Service Levy Under s85a (10A) of the Environmental Planning and Assessment Act 1979 a complying development certificate cannot be issued until any long service levy payable under section 34 of the Building and Construction Industry Long Service Payments Act 1986 (or where such a levy is payable by instalments, the first instalment of the levy) has been paid. The local council may be authorised to accept payment.