Application for Construction Occupation 
Licence Individual 
Plumbing Plan Certifier
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 a plumbing plan certifier licence to provide plumbing certification services 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 by Access Canberra then Access Canberra cannot process your application. The personal information you provide may be disclosed to the other areas of ACT Government 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 on http://www.cmd.act.gov.au/legal/privacy.  

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

Approved form AF2016‐49 approved by Ben Green, Deputy Construction Occupations Registrar on 27 June 2016 under
section 128 of the Construction Occupations (Licensing) Act 2004 and revokes AF-2015-122	

Section B — Existing licence
Have you previously or do you currently hold an ACT construction occupation licence?

 Yes — licence Number				 expiry date				

 No — proceed to Section C – Occupation class and functions.
Section C — Occupation class and functions
A plumbing plan certifier is an entity that provides, has provided or proposes to provide a plumbing certification service. A plumbing certification service is the doing of plumbing plan certification work under the Water and Sewerage Act 2000. 
Section D — Evidence of qualifications/eligibility – Principal Building Surveyor 
Method One:
Registration Type:	Registration by the Institution of Engineers Australia on the national professional engineers register in the area of practice of “building services”

 Yes — please attach a certified copy of your registration.

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

Qualification Type:	Statement of competency in hydraulic systems from the Institution of Engineers Australia

 Yes — please attach a certified copy of the statement of competency.

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

Experience:	You must demonstrate that you have knowledge of AS/NZS 3500 – Plumbing and Drainage

 Yes — please attach a detailed resume showing a history of working on AS/NZS 3500 and references from suitably licensed referees (individuals who currently hold a plumbing plan certifier licence) that you have worked under.

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

Method Two:

Licence Type:	A sanitary plumber licence and an advanced sanitary drainer licence that you have held for a minimum of three years.

 Yes — please note licence details and expiry date below.

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

Licence number 					 Licence Expiry 					

Qualification Type:	successful completion of the backflow prevention course issued by a Registered Training Organisation.

 Yes — please attach a certified copy of the certificate.

 No — please note that you may not be eligible for a licence.
Section E — Insurance Requirements
A plumbing plan certifier must have adequate insurance to be eligible for a licence.  The insurance certificate must state that the applicant is an insured person under the policy.  In the event that the insurance policy is in a corporation’s name, then a Director of that corporation must also meet the minimum requirements as prescribed under 18(2) of the Construction Occupations (Licensing) Regulation 2004 (the regulation).  

Part 18(2) of the regulation states ‘an applicant is adequately insured if the applicant has professional indemnity insurance that provides: 

a)	indemnity against claims for breach of professional duty as a plumbing plan certifier; and 
b)	a minimum limit of indemnity of $1,000,000 for each period of insurance. 

 Yes — please attach a certified copy of the insurance, and if required, a copy of the insurance policy disclosure document. 

 No —  please note that you may not be eligible for a licence.
Section F — Evidence of Financial Resources
Evidence of financial resources is required to help demonstrate your ability to fulfil contractual obligations when providing construction services.  Failure to provide information below may result in your licence being refused. 

1.	Do you have access to financial resources adequate to complete works performed under the licence applied for?  

 Yes – please skip the next question.				

 No – complete next question.

2.	If ‘No’ to the above, do you wish to only operate as an employee under the licence applied for?

 Yes – I understand a condition may be imposed on the licence if issued.  

 No— if you do not wish to have a licence restricted to employee only, then you must ensure you have financial resources as requested above or you may be ineligible for a licence).

3.	Are you currently, or previously have been, deemed bankrupt or personally insolvent? 

 Yes – please attach details and official documentation of bankruptcy/insolvency.    		

 No.

4.	I understand that it is a requirement under law that should my licence be issued, I must notify the Construction Occupations Registrar should I become bankrupt or personally insolvent?  

 I have read and understand the above statement.

Section G — Licence History Declarations
1.	Have you previously held a plumbing plan certifier licence elsewhere in Australia or overseas? 

 Yes —provide details below of most recent licence/s (attach an additional page if required)   No

	State/Territory/Country ___________________________Expiry date:   ______/______/______  

2.	Is your licence as a plumbing plan certifier, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

3.	Have you previously had a plumbing plan certifier licence cancelled, refused or suspended in Australia or overseas?      

 Yes — you must provide comprehensive details in an attachment to this application	 No

4.	I understand that I must notify the Construction Occupations Registrar if my plumbing plan certifier licence is cancelled, refused or suspended in Australia or overseas.  

 I have read and understand the above statement. 

5.	Has your plumbing plan certifier licence ever been subject to conditions, undertakings, limitations or restrictions in Australia or overseas?  

 Yes — you must provide comprehensive details in an attachment to this application	 No

6.	Are you disqualified under the Construction Occupations (Licensing) Act 2004, or a corresponding prior Act, from applying for licence, or being licensed, in a construction occupation? 

 Yes – you must provide comprehensive details in an attachment to this application	 No

7.	Have you ever been, or are you currently, the subject of complaints, occupational discipline, demerit activity or rectification orders whilst licensed under the Construction Occupations (Licensing) Act 2004, a corresponding prior Act, or the law of another jurisdiction in Australia or overseas, where those proceedings were not finalised?    

 Yes – you must provide comprehensive details in an attachment to this application	 No

8.	Have you been convicted or found guilty of a criminal offence* that involves fraud, dishonesty or violence and is punishable by imprisonment of 1 year or more? 

 Yes — you must provide comprehensive details in an attachment to this application 	 No
  and a recent criminal history check  (issued in the last three months)				
*Please note: Spent convictions under the Spent Convictions Act 2000 do not need to be included in this declaration

9.	I understand that it is a requirement under law that should my licence be issued I must notify the Construction Occupations Registrar if I am convicted of such an offence in the future.  

 I have read and understand the above statement.

10.	I understand that it is a requirement under law that should my licence be issued I must not perform any licensable plumbing plan certification services that are outside the scope of what the licence authorises.  

 I have read and understand the above statement. 

11.	I understand that it is a requirement under law that should my licence be issued  I must give evidence to clients of the insurance I hold as a licensed individual in relation to any relevant licensable construction service I intend to undertake prior to providing the services. 

 I have read and understand the above statement.

12.	I understand that it is a requirement under law that should my licence be issued I must only advertise licensable construction services with my full name (as it appears on the licence) and my individual licence number.*  

 I have read and understand the above statement.

*Please note: It is an offence to advertise licensable construction services as an individual without including the above.

13.	I understand that it is a requirement under law that should I be granted a licence, all licensable plumbing plan certification services I may perform under my licence must comply with all relevant legislation, codes and standards. 

 I have read and understand the above statement.

Please note: Plumbing plan certification work may be audited by the Construction Occupations Registrar in the ACT for compliance against the relevant laws. Individual licence holders identified performing non-compliant services may be subject to occupational discipline or other licensing action.
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, is/are accurate, true and correct.

2.	 I authorise and consent:

a)	to the Construction Occupations Registrar and 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 building surveyor 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 							Date:			
Section I — Payment Details
Upon lodgement of your application you will be required to pay an application assessment fee.  This fee is non‑refundable. You will be provided with a notice of decision in relation to your application. If your application is approved a licence term fee will be payable prior to the issue of your licence.  
View the Access Canberra Website for licence application fee and charges.
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 8096
Email: cwpl@act.gov.au