Application for Construction Occupation Licence Individual  
Owner Builder
Construction Occupations (Licensing) Act 2004, s128 and s17	

This approved form is to be used for individuals applying under the Construction Occupations (Licensing) Act 2004 to the Construction Occupations Registrar for an owner builder licence in the ACT.  This application will not be considered unless it is complete and all supporting documentation provided.

All supporting documentation must:
•	be originals or certified true copies of original documents where relevant; and
•	be in English. If original documents are not in English, you must provide a certified copy of the original document and an official translation of the document.

Privacy Notice 
The personal information on this form is provided to Access Canberra of the ACT Government to enable the processing of your application. If all or some of the personal information is not collected, Access Canberra cannot process your application. The personal information you provide may be disclosed to the other ACT Government Directorates, and third parties external to the ACT Government, as required by specific legislations administered by Access Canberra. The Information Privacy Policy Annex contains information in regard to what information Access Canberra collects and to whom it is disclosed. The policy also contains information about how you may access or seek to correct your personal information held by Access Canberra, and how you may complain about an alleged breach of the Territory Privacy Principles. The Information Privacy Policy can be found at http://cmd.act.gov.au/legal/privacy_statement.  

Section A — Personal Details
Title 		 Surname 									 

Given Names							Date of Birth	    /	  /	

Business Address											 

Suburb 					State				Postcode 		

Residential Address										 

Suburb 					State				Postcode 		
	
Postal Address 											           

Suburb 					State				Postcode 		

Phone Number (Business Hours) 				Fax 					

Mobile Number* 				Email*							

*Please note that under S170 of the Construction (Occupations) Licensing Act 2004 it is a requirement to provide a valid mobile telephone number and email address. 

I understand that it is a requirement under law that should my licence be issued I must notify the Construction Occupations Registrar of any changes to my details within two weeks of the change.

 I understand

Section B — Owner Builder 
An Owner Builder licence authorises the licensee to undertake building work (other than specialist building work) in relation to a Class 1, 2 or 10a building that is, or is to be, the licensee’s main home or ancillary to it. 
Section C — Site Details 
Block 			Section 				Suburb					 
Section D — Description of Building work
Description of Building Work: 									

												
Section E —Appointed Building Certifier and Building Approval Details
Building Certifier Name: 						Licence Number			

Building Approval Issue Date:					

Please attach a copy of the building approval to this application ensuring that the Building Approval stamp is clear and the type of work being undertaken is clear.  A Building Approval must be obtained from a Private Certifier prior to submitting this application.

Section F —Evidence of qualifications/eligibility 
Complete this section only if you are applying for an Owner Builder licence to construct a building that is classified as a Class 1 or 2 building under the Building Code of Australia.

Requirement: 		An Owner Builder course certificate issued after 1 January 2010 

 			or

	An ACT Class A, B or C Builder’s licence or interstate equivalent. 

 Yes	— please attach certified copies of requirements to this application.

 No 	— please note that you may not be eligible for a licence. 

Section F —Evidence of qualifications/eligibility – BCA Class 10a Structure
Complete this section only if you are applying for an Owner Builder licence to construct a structure that is classified as a class 10a structure under the Building Code of Australia.

Requirement: 		An Owner Builder course certificate issued after 1 January 2010 

 			or

	An ACT Class A, B, C or D Builder’s licence or interstate equivalent. 

 Yes	— please attach certified copies of requirements to this application.

 No 	— please note that you may not be eligible for a licence. 

Section G — Licence History Declarations
1.	Are you a lessee of the land where the proposed construction is to take place?

 Yes	 

 No — Please note you may not be eligible for a licence only an individual lessee of the land can be issued with an Owner Builder licence.
2.	Have you previously held an Owner Builder licence in the ACT within the last five years on a different block of land?

 Yes — You may not be eligible for a licence.  Owner Builder licences cannot be issued to an individual who has been granted an Owner Builder licence within the last five years prior to making this application unless it was for the same parcel of land.

 No 	 
3.	Is the building work in relation to your main home or ancillary to that home?

 Yes	

 No — please note that you may not be eligible for a licence.

Section H — Consent and Application Declarations
I, ________________________________________________________________________________________,
 			Insert name, address and occupation of person making the declaration

make the following declaration:

1.	I declare:

a)	that I make this application to the Construction Occupations Registrar for a construction occupations licence and that all statements, and the information/documents provided in support of the application, are accurate, true and correct.

2.	I authorise and consent:

a)	to the Construction Occupations Registrar and Environment Access Canberra to make enquiries of, and exchange information with, the relevant regulatory authorities of any Australian State or Territory, or other country, regarding my construction occupation licence and practice as a Builder or otherwise regarding matters relevant to this application.

b)	to receiving information from the Construction Occupations Registrar relevant to my construction occupation licence or the construction industry electronically.

3.	I acknowledge:

a)	that the Construction Occupations Registrar and Access Canberra may validate documents provided in support of this application or wish to confirm my identity.

b)	that failure to complete all relevant sections of this application and enclose all supporting documentation may result in this application not being accepted or additional fees being applied as per the statutory instrument authorising fees to be taken under the Construction Occupations (Licensing) Act 2004.

c)	that the Construction Occupations Registrar has the legal right to refuse my application if not satisfied that I am eligible to hold a licence or impose a condition on my  licence if it is deemed necessary or desirable to protect the public.

4.	Should I be issued with a construction occupations licence I undertake:

a)	to comply with the Construction Occupations (Licensing) Act 2004 (and it’s operational Acts) and the codes, standards and guidelines relevant to my construction occupation licence when providing, or offering to provide, a relevant construction service.

5.	 I believe that the statements (1 - 4) in this declaration are true and correct.

Signature of Applicant (lessee)						Date 	       /           /    	  

All other lessees of the land where the building work is to be undertaken must authorise this application for an Owner Builder licence:

Name 																
Signature							 Date 	       /           /    	

Name 																
Signature							 Date 	       /           /    	  

Name 																
Signature							 Date 	       /           /    	  
Section I — Payment Details
Upon lodgement of your application you will be required to pay an application assessment fee. This fee is $223.00 and is non‑refundable. 

You will be provided with a notice of decision in relation to your application. Please note that additional fees may apply if you submit an incomplete application without required supporting documents. 

Section J — Lodgement and Contact Information
Access Canberra Environment Planning and Land Shopfront 
GPO Box 1908, Canberra City 2601 
16 Challis Street, Dickson ACT 2602 
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays) 
Phone: (02) 6207 1923 
Email: epdcustomerservices@act.gov.au