Fillable DOMESTIC BUILDER LIMITED (CARPENTRY) (Department of Infrastructure, Transport, Cities and Regional Development)

Fill Online, Printable, Fillable, Blank DOMESTIC BUILDER LIMITED (CARPENTRY) (Department of Infrastructure, Transport, Cities and Regional Development) Form

Use Fill to complete blank online DEPARTMENT OF INFRASTRUCTURE, TRANSPORT, CITIES AND REGIONAL DEVELOPMENT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

DOMESTIC BUILDER LIMITED (CARPENTRY) (Department of Infrastructure, Transport, Cities and Regional Development)

On average this form takes 145 minutes to complete

The DOMESTIC BUILDER LIMITED (CARPENTRY) (Department of Infrastructure, Transport, Cities and Regional Development) form is 25 pages long and contains:

  • 0 signatures
  • 605 check-boxes
  • 299 other fields

Country of origin: AUSTRALIA
File type: PDF

Use our library of forms to quickly fill and sign your Department of Infrastructure, Transport, Cities and Regional Development forms online.

BROWSE DEPARTMENT OF INFRASTRUCTURE, TRANSPORT, CITIES AND REGIONAL DEVELOPMENT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1/20
VBA will:
Please provide:
How to apply:
Save and complete this form on your computer. Do not handwrite.
How to submit your application:
Please fill out your application, print and sign a hard copy and submit your application.
By mail:
Victorian Building Authority
GPO Box 536
Melbourne VIC 3001
Or in person at the VBA:
Goods Shed North
733 Bourke Street
Docklands VIC 3008
DOMESTIC BUILDER LIMITED
(CARPENTRY)
REGISTRATION
APPLICATION
FORM
Your industry
qualifications
Project
work
evidence
Technical
referee
report
Police check,
photo ID &
declarations
Authorise
payment
& submit
Review
your
application
Assess your
knowledge &
experience
Conduct
a reference
check
Make a
decision
on your
application
Notify
you of the
outcome
2/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
A
Title*:
☐
Mr
☐
Mrs
☐
Ms
☐
Miss
☐
Other______________________________
First name*
Middle name
Surname*
Date of birth*
/ /
Your contact details
Email*
Mobile number*
Home telephone
Your residential address (must not be a post office box)
Street no. and name*
Suburb*
State*
Postcode*
Your postal address
(if different from residential address)
Street no. and name*
Suburb*
State*
Postcode*
YOUR BUSINESS DETAILS
Your business address
(will be listed in the public register once your application has been granted)
Street no. and name*
Suburb*
State*
Postcode*
Business email
Fax number
Business telephone
ANY CURRENT REGISTRATIONS
Are you currently registered as a building practitioner in Victoria in any category or class of building practitioner?
NO
YES If yes, please enter your registration number/s:
ANY OTHER LICENCES AND/OR REGISTRATIONS?
YES
NO
(a)
Are you currently authorised to perform building work outside of Victoria?
☐ ☐
(b)
Have you previously been (but not currently) authorised to perform building work outside of Victoria?
☐ ☐
(c) Do you hold a current licence to perform high risk work issued by an Australian state or territory workplace
health and safety regulator?
☐ ☐
(d) Do you hold a current Construction Induction Card (White Card) issued by an Australian state or territory
workplace health and safety regulator?
☐ ☐
Continue over page
3/20
Domestic Builder Limited (carpentry) - Registration
Application SD-APP-011 V2
If you answered YES to any questions regarding other licences/registrations, complete the table below, with
details as requested. Please attach certified photocopies of each. See who can certify your documents.
Attachments (tick)
Type
(licence/registration)
Regulator name
(issuer of licence/registration)
State
Date
(first issued)
Number
(licence/registration)
Lic/Reg
(certified)
Builder – Occupational
Licence
Queensland Building and
Construction Commission
QLD mm/yy ############
☐
☐
☐
☐
If you require more room, please attach an additional page
PART B
RELEVANT QUALIFICATIONS
For each qualification that you list below, please attach certified photocopies of:
1. The qualification, issued by the University, TAFE, or Registered Training Organisation, and
2. Your record of results stating the units of competency/subjects.
See the relevant qualifications for registration in this class.
See who can certify your documents.
Attachments (tick each)
Name of qualification
Institution
(TAFE, University, RTO)
Year
completed
Qualification
Results
X
Certificate III in carpentry
(CPC30211)
Holmesglen Institute
dd/mm/yy
☐ ☐
1
☐ ☐
2
☐ ☐
3
☐ ☐
4
☐ ☐
5
☐ ☐
If you require more room, please attach an additional page
✔
✔
✔
4/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
PART C
EMPLOY
MENT HISTORY - BUILDING
Employer 1*
Employer/supervisor name
Supervisor’s position/title
Employer/supervisor primary contact number
Their building practitioner registration number (if applicable)
Their company name
Your position/title at time of employment
Dates of your employment:
From
/ /
To
/ /
Address of employer 1
Street no. and name
Suburb
State
Postcode
Employer 2*
Employer/supervisor name
Supervisor’s position/title
Employer/supervisor primary contact number
Their building practitioner registration number (if applicable)
Their company name
Your position/title at time of employment
Dates of your employment:
From
/ /
To
/ /
Address of employer 2
Street no. and name
Suburb
State
Postcode
Employer 3*
Employer/supervisor name
Supervisor’s position/title
Employer/supervisor primary contact number
Their building practitioner registration number (if applicable)
Their company name
Your position/title at time of employment
Dates of your employment:
From
/ /
To
/ /
Address of employer 3
Street no. and name
Suburb
State
Postcode
If you require more room, please attach an additional page
5/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
PART D
EXPERIENCE
SECTION 1
Building project work history
Please list details of relevant domestic building work that you have undertaken in the last seven years.
Site address
Registered building
practitioner detail
(Their name &
registration number)
Construction
details
(Include: Class of building,
type of construction (A, B,
C), number of storeys, &
number of basement levels)
Permit no.
Your role
(e.g.: Project
manager,
Supervisor,
Subcontractor,
or other)
Dates
worked
‘From’ and ‘to’
(mm/yyyy)
Onsite
hours per
week
123
Alphabet St.
Melbourne
3000 Victoria
Joe Builder
DB-U 65234
Class 5,
Type B,
1 storey
1 basement level
##########
Supervisor
06/2016 –
09/ 2016
31 hours
Continue over page
6/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
SECTION 1 continued
Building project work history
Please list details of relevant domestic building work that you have undertaken in the last seven years.
Site address
Registered building
practitioner detail
(Their name &
registration number)
Construction
details
(Include: Class of building,
type of construction (A, B,
C), number of storeys, &
number of basement levels)
Permit no.
Your role
(e.g. Project
manager,
supervisor,
subcontractor,
or other)
Dates
worked
‘From’ and ‘to’
(mm/yyyy)
Onsite
hours per
week
123
Alphabet St.
Melbourne
3000 Victoria
Joe Builder
DB-U 65234
Class 5,
Type B,
1 storey
1 basement level
##########
Supervisor
06/2016 –
09/ 2016
31 hours
If you require more room, please attach an additional page
7/20
Domestic Builder Limited (Carpentry) - Registration Application
SD-APP-011 V2
Size A3
1 set of elevations
(architectural)
Size A4
Photos at each stage
including:
1) Footings
2) Frame
3) Completion
Max. 10 photos per project
(if available)
Size A3
Engineer’s drawings
(if relevant)
+
SECTION 2
Portfolio - three building projects in detail
Please select three projects from your building project work that best demonstrate your experience in the relevant
components of domestic building work. You will need to provide evidence documents for each project, including
technical referee/s to verify your experience.
INSTRUCTIONS
1) Ensure that each project:
•
Was undertaken within the last seven years.
•
Shows all aspects of end-to-end construction (or alternatively provide a selection of projects which show
each component of relevant building work).
2) For each project provide photocopies of the following documents:
If you do not provide the above documents, your application for registration may not be accepted.
Size A4
Building permit
documents – form
1&2, and if available
forms 15, 16 & 17
Size A3
1 x Floorplan
(architectural)
+
+
Size A3
1 x section through
building
(architectural)
Size A3
1 site plan including
setbacks and
boundaries
+
+
8/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
SECTION 3
Demonstrated experience
Please list the site addresses of the 3 building projects you chose to demonstrate your experience with.
Project 1
Project 2
Project 3
Explanation of terms
Please indicate the components of building work relevant to domestic building work that you either assisted, carried
out or managed in each of your chosen three building projects.
Did you assist, or manage any of the following components of building work per project?
Component of
building work
Project 1 Project 2 Project 3
Assisted
Managed
Assisted
Managed
Assisted
Managed
Preliminary work
Determined requirement for building permit
☐ ☐ ☐ ☐ ☐ ☐
Obtained building permit/ or approvals from other
authorities
☐ ☐ ☐ ☐ ☐ ☐
Prepared contracts for the building work
☐ ☐ ☐ ☐ ☐ ☐
Administered appropriate contracts
☐ ☐ ☐ ☐ ☐ ☐
Managed contract variations and defects
☐ ☐ ☐ ☐ ☐ ☐
Arranged/attended mandatory inspections
☐ ☐ ☐ ☐ ☐ ☐
Completed handover including certificates of compliance
☐ ☐ ☐ ☐ ☐ ☐
Managed the building work from start to finish
☐ ☐ ☐ ☐ ☐ ☐
Assisted
Refers to when you have assisted a competent and qualified practitioner in the carrying out of a
particular component of building work.
Carried out
T
he actual hands-on carrying out of building work. It refers to when you have been solely responsible for
that component of building work.
Managed
The management of building work. It refers to when you were not involved in the actual carrying out of
that component other than engaging a competent practitioner to do so
; however, you as the
manager/supervisor
were responsible for the quality and compliance of that component of work.
9/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
Did you assist, or manage any of the following components of building work per project?
Component of
building work
Project 1 Project 2 Project 3
Assisted
Managed
Assisted
Managed
Assisted
Managed
Continued
Conducted business and financial aspects for projects
☐ ☐ ☐ ☐ ☐ ☐
Prepared cost estimates and quotations for project/part
of project
☐ ☐ ☐ ☐ ☐ ☐
Site supervision
Developed and monitored progress schedules for the
work
☐ ☐ ☐ ☐ ☐ ☐
Provided on-site day to day supervision of the project
☐ ☐ ☐ ☐ ☐ ☐
Supervised subcontractors/trades to ensure work is
conducted safely & to standard
☐ ☐ ☐ ☐ ☐ ☐
Managed site safety throughout the project
☐ ☐ ☐ ☐ ☐ ☐
Did you assist, carry out or manage any of the following components of building work per project?
Component of
building
work
Project 1 Project 2 Project 3
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Pre -base work
Interpreted architectural plans, drawings and
specifications
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Interpreted engineering designs, plans, drawings
and specifications
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Carried out excavation work
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Established the construction site
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Provided protection works for the adjoining
property
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Set out the site for construction/carpentry work
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Base work
Constructed retaining walls
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed stump and pad footing systems
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed sub-floor framing
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
10/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
Did you assist, carry out or manage any of the following components of building work per project?
Component of
building
work
Project 1 Project 2 Project 3
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Base work
Installed bored piers
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed screw piles
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed formwork for concrete slabs on-
ground
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed formwork for concrete suspended
slabs
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed concrete reinforcement
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed damp-proofing
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed termite protection
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Frame work
Constructed wall framing – stick build
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed wall framing - prefabricated
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed structural steel elements
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed roof framing – stick build
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed roof framing – prefabricated truss
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Selected and installed bracings/fixings
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed fire rated party walls
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed and erected metal wall frames and
roof frames
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed sheet flooring, plywood flooring,
waterproof cement sheet flooring
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Straightened internal walls
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed
windows and doors including appropriate
flashings
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed insulation
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
11/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
Did you assist, carry out or manage any of the following components of building work per project?
Component of
building
work
Project 1 Project 2 Project 3
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Assisted
Carried
out
Managed
Lock-up work
Internal/external services rough-in
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed eaves framing and installation of
eaves lining
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed timber weatherboard or other external
cladding
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Fix work
Selected and installed waterproofing
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed architraves and skirtings
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed cabinets and components on site
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed cabinets and joinery
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Manufactured, assembled and installed internal
stairs
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Other work
Constructed external decks with sub-floor framing
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed fences and gates
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Landscaped – including structural landscaping
work
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Demolished an existing bathroom, kitchen or
laundry
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed fixtures such as baths, shower bases,
spas
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed wall and ceiling linings, including wet
area lining
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Selected and applied appropriate waterproofing
systems
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Altered window and/or door openings
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed joinery for basins, sinks, troughs
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Installed shower screens and mirrors
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Constructed swimming pool or safety barriers
and/or other gates and fences
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Continue over page
12/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
PART E
TECHNICAL REFEREE REPORT
With your application please submit at least one Technical Referee Report - download here. Your referee should be a registered
Domestic Builder (Unlimited) or a Domestic Builder Limited (Carpentry) and have directly supervised you carrying out the work
listed in all or one of the projects you have listed. You may need more than one referee to cover all components of building
work.
PART F
NATIONAL POLICE CHECK VIA ONLINE PROVIDER
PART G
PARTNERSHIPS
Are you carrying out, or intending to carry out, work as a partner in a business partnership?
YES
NO
If YES, complete details below and ensure that each partner completes a separate Partner Declaration and
submit along with this application.
Partnership name
ABN
Partnership trading name
PARTNER DETAILS
Enter details for each partner
(excluding you) in the table below.
Partner 1
Partner 2
Contact Detail
Full name
Contact number
Email address
Postal Details
Street no. and name
Suburb
State
Postcode
If you require more room, please attach an additional page
To support your application, we require you to undertake a national police check. To apply, visit the VBA police check portal and
follow the steps. Upon completion, fill out the declaration below.
☐ I declare that I have completed an Australia Post police check, on date: / /
Please note: If you do not utilise the above link to complete your police check, you will be charged.
Please note: If you do not complete your police check, your application will be returned to you.
✔
13/20
1
Associate means someone who exercises significant influence over you or your business
2
Meaning the Building Practitioner Board, Building Appeals Board, Victorian Civil and Administrative Tribunal or the VBA
3
Similar registration means a registration, licence, approval, certificate or other form of authorisation under a corresponding Act that corresponds
to a relevant registration
4
Offences as defined in the following legislation: section 10, 11, 12, 17, 19 or 21 of the Fair Trading Act 1999, section 53, 55, 55A, 56, 58 or 60 of
the Trade Practices Act 1974 (Cth), section 29, 33, 34, 35, 36, 50, 151, 157, 158 or 168 of the Australian Consumer Law (Victoria), section 29, 33,
34, 35, 36, 50, 151, 157, 158 or 168 of Schedule 2 to the Competition and Consumer Act 2010 (Cth)
PART H
DECLARATION
You must truthfully answer all of the following questions by ticking the appropriate boxes.
EXCLUDED PERSONS
If you are an ‘excluded person’ as defined in 171F of the Building Act, then your application for registration cannot be
granted. To assist the VBA in assessing your application, please answer all of the following questions. If you do not
answer all of the questions, this will delay the determination of your application.
YES
NO
(a)
Are you or an associate
1
currently disqualified by an order of a disciplinary body
2
from applying for registration?
☐ ☐
(b) Have you or an associate previously held a building practitioner registration within Victoria or outside Victoria
that was cancelled due to disciplinary action, and you or your associate are:
i. currently disqualified from applying for registration; or
☐ ☐
ii. less than two years after the day the cancellation occurred if you or your associate were not disqualified
☐ ☐
(c) Have you applied for a building practitioner registration in Victoria, or a similar registration
3
in another
jurisdiction, within the last two years and the application was refused because you provided false and misleading
information?
☐ ☐
(d)
Are you a represented person under the Guardianship and Administration Act 1986?
☐ ☐
PERSONAL PROBITY
YES
NO
Within the last 10 years (whether in Victoria or outside Victoria):
(a) Were you convicted or
found guilty of any offence involving fraud, dishonesty, drug trafficking or violence where
that offence is punishable by imprisonment for 6 months or more?
☐ ☐
(b) Were you convicted or found guilty of an offence under any law regulating building work or building
practitioners?
☐ ☐
(c) Did you have any registration, licence, approval, certificate or other type of authorisation as a building
practitioner suspended or cancelled for any reason other than your failure to renew this authorisation?
☐ ☐
(d) Were you convicted or found guilty of an offence
4
involving:
i. misleading conduct in relation to goods or services
☐ ☐
ii. false or misleading representation in relation to goods or services
☐ ☐
iii. bait advertising
☐ ☐
iv. accepting payment without intending or being able to provide services or goods
☐ ☐
v. harassment or coercion in connection to goods, services, payment of goods or services or the sale, grant (or
possible sale or grant) of interest in land, or payment for interest in land.
☐ ☐
(e) Has a court or the Victorian Civil and Administrative Tribunal (VCAT) subjected you to an order that you failed to
comply with within the period required by the court or VCAT, where the order was issued under:
i. the Building Act 1993 or regulations under that Act?
☐ ☐
ii. the Domestic Building Contracts Act 1995 or the regulations under that Act?
☐ ☐
14/20
5
Under Part 2D.6 of the Corporations Act 2001
6
Referred to in section 137A or 137B of the Building Act 1993
7
Within the meaning of the Domestic Building Contracts Act 1995
FINANCIAL PROBITY
You must truthfully answer all of the following questions by ticking the appropriate box.
YES
NO
☐ ☐
(a) Are you or have you ever been an insolvent under administration?
(b) Are you, or have you ever been, disqualified from managing corporations
5
?
☐
(c) Has an insurer ever declined, cancelled, or imposed special conditions on any indemnity insurance
related to your work as a building practitioner in Victoria or in an equivalent building occupation in
another State or Territory?
☐ ☐
(d) Do you (personally or as company director) have any outstanding judgment debt:
i. for amounts recoverable by an insurer under a policy of insurance for domestic building work
6
that has not been satisfied within the period required to do so?
☐ ☐
ii. owed to the VBA as a debt due under this Act that has not been satisfied within the period required
to do so?
☐ ☐
iii. in relation to a domestic building dispute that has not been satisfied within the period required to
do so?
☐ ☐
(e) Do you (personally or as company director) have any outstanding amounts payable, either under a
dispute resolution order
7
or a Victorian Civil and Administrative Tribunal order in relation to a
domestic building dispute, that has not been paid within the period required by the order?
☐ ☐
(f) Do you (personally or as company director) have any outstanding unpaid adjudicated amount due
to be paid under the Building and Construction Industry Security of Payment Act 2002 if:
i. the period for making an adjudication review application under that Act for that amount has
expired, and if
☐ ☐
ii. an adjudication review application in relation to that amount was not lodged?
☐ ☐
(g) Have you ever been the director of a company when that company had any outstanding judgment
debt or unpaid amount referred to in paragraph (d) and (e) and (f) above?
☐ ☐
If you answered YES to any of the questions relating to personal probity or financial probity, please provide
details here:
1) What were the offences or breaches?
2) When did the event occur?
3) In which State or Territory did the event occur?
4) What were the circumstances of the event?
FINANCIAL PROBITY continued
5) What penalty did you receive?
6) What have you done to prevent the event from occurring again?
If you require more room, please attach an additional page under the heading ‘Personal/Financial Probity’
15/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
(h) Have you performed any of the following roles for a company (or companies)
within two years of that company (or companies) going into external
administration?
• Director
• Secretary
• Influential person
Definitions
'Influential person' means, in relation to a company, a natural person (other than a director or
secretary of the company), who is in a position to control or substantially influence the company's
conduct.
'External administration' occurs when (a) a liquidator or provisional liquidator has been appointed; (b)
the company is under administration; or (c) a deed of company arrangement (DOCA) has been entered
into. For the purposes of this form, a company is not under external administration merely because a
receiver and manager or other controller has been appointed.
If you answered Yes to the declaration above, please complete the External Administration Declaration form. If the
declaration relates to multiple companies, please complete separate forms for each company.
If you answered No to the declaration above, continue to Part I of this application form.
FINANCIAL PROBITY continued
You must truthfully answer all of the following questions by ticking the appropriate box. YES NO
16/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
17/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
PART I
PHOTO REQUIREMENTS
If your application for registration is granted, we will issue you with an identification card showing your name, your
photograph, the category and class of building practitioner in which you are registered, and any limitations
imposed on your registration.
You must provide a photo of yourself with your application.
☐
Print your name on the back
☐
Affix photo in the space below with double sided tape
☐
Do not place any tape or staples on the front of the photo
The photo must be:
• In colour
• Less than six months old
• 4.5–5cm in height and 3.5–4cm in width without a border
• Good quality gloss prints on photo paper
In the photo, you must:
• Be in sharp focus
• Have a plain, light-coloured background
• Be uniformly lit (no shadows or reflections)
• Look directly at the camera
• Not have hair or garments covering your face
• Have a neutral expression (not laughing, smiling or frowning)
For office use only
Application reference number
Practitioner identification number
AFFIX
PHOTO
HERE
✔
✔
✔
18/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
PART J
FEES
Payment details*
Please select your payment method and complete the details as requested. Please Note: The VBA does not accept cash.
Money order
Please make cheques and money orders payable to: Victorian Building Authority.
Credit Card: Name of Cardholder
Visa Mastercard
Amount Card number Card expiry
/
Signature of card holder: ____________________________________
(must be handwritten)
Date of signature: ______________
PART K
YOUR SIGNATURE
It is an offence under section 246 of the Building Act 1993 to give false or misleading information in
relation to an application for registration. This offence carriers a maximum penalty of 120 penalty units.
☐
I declare that the information contained in this application, including attachments, is true and correct.
By signing this, I declare that I have read and understood how the VBA manages my personal information and
the VBA's Privacy Collection notice, as stipulated on the final page of this document.
Applicant signature: Date of signature:
/ /
(must be handwritten)
If you are NOT currently registered in Victoria in any other category or class of building practitioner, then the fee
to lodge this application is $782.80.
If you ARE currently registered in Victoria in a category or class of building practitioner, and were registered:
On or before 21 May 1999, then the fee to lodge this application is $768.30
After 21 May 1999, then the fee to lodge this application is $420.50
Please select amount
✔
19/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2
Before submitting your application
REMINDER CHECKLIST
Have you provided:
☐
Your police check reference number
☐
Your photo ID
Have you attached certified photocopies of:
☐
Your qualifications
☐
Your statement of results
For the three projects you listed in your building work history:
☐
Size A4 Building permit documents
– form 1&2, and if available forms 15, 16 & 17
☐
Size A4 Photos at each stage of project including:
1) Footings
2) Frame
3) Completion
Max. 10 photos per project (if available)
☐
Size A3 1
x set of elevations (architectural)
☐
Size A3 1 x section through building (architectural)
☐
Size A3 1
x site plan including, setbacks and boundaries
☐
Size A3 1 x
floorplan (architectural)
☐
Size A3 Engineer’s drawings
☐
Technical Referee
Report (at least one)
20/20
Domestic Builder Limited (Carpentry) - Registration
Application SD-APP-011 V2, End of form
Privacy collection notice
How the VBA uses and discloses your personal information
The Victorian Building Authority (VBA) is collecting your personal information (including any images or photographs and any and
all details provided in this form), to process your application. If you do not provide all or any part of the information requested in
this form, the VBA may be unable to process and subsequently grant your application. The VBA may also use such information
for the following purposes:
(a) To enable the VBA to meet its statutory obligations, functions and perform its operational requirements.
(b) Researching and assessing the merit and impact of proposed regulatory reforms and to assist in the development and
delivery of services by the VBA (whether to you personally or a member of the public).
(c) Law enforcement by the VBA or other regulatory bodies, including prosecutions or disciplinary action against you if
required.
(d) Maintaining disciplinary and licensing and registration registers for building and plumbing practitioners (published on the
VBA’s website).
(e) Such other purposes as required by law or authorised under the privacy legislation.
The VBA may also share your personal information with third parties including, but not limited to, different business units within
the VBA, the Building Appeals Board, Consumer Affairs Victoria, the Victorian Managed Insurance Authority, your insurer, other
regulators (both in Victoria and interstate), your clients or customers and the VBA’s staff and/or service providers who need to
know such information to perform services for the VBA.
The VBA will only disclose your personal information to a third party claiming to act on your behalf (for example, an agent or
interpreter) with your prior written consent, unless it is otherwise apparent that the third party has authority to act on your
behalf.
You can request access to the personal information, the VBA holds about you. If you become aware that personal information
the VBA holds about you is not accurate, complete or up to date, you can ask the VBA to correct it.
The VBA’s full Privacy Policy and information about how to contact the VBA is available at www.vba.vic.gov.au/legal/privacy.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

DOMESTIC BUILDER LIMITED (CARPENTRY) (Department of Infrastructure, Transport, Cities and Regional Development)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document