COMPLIANCE CERTIFICATE – BUSHFIRE CONSTRUCTION
                       Issued under Section 109C(1)(a) Environmental Planning & Assessment Act 1979
             I "insert builders / owner builder name" ……………………………………………………..
             Certify that bushfire construction for the building at:
             Property details:
             Lot No:     …………………. DP:……………………………………………………….....
             Address:    ………………………………………………………………………………………
                         ………………………………………………………………………………………
             Construction Certificate Application No: …………………………………………………
             Complying Development Certificate No: ………………………………………………….
             Building Code of Australia (BCA) Classification:      Class 1(a) / Class 10(a)
                  Has been constructed to:
                   ☐Level 1 Construction AS 3959-1999      ☐BAL 19 AS 3959-2009
                   ☐Level 2 Construction AS 3959-1999      ☐BAL 29 AS 3959-2009
                   ☐Level 3 Construction AS 3959-1999      ☐BAL 40 AS 3959-2009
                   ☐BAL 12.5 AS 3959-2009                  ☐BAL FZ AS 3959-2009
                   “Planning for Bushfire Protection 2006”, the Building Code of Australia and the 
                   condition/s of approval, at the above address.
             Certified and dated this day: ………………………………………………………………
             By Name:
             (builders / owner builder name): ……………………………………………………………..
             Licence No: …………………………………………………………………………………….
             As a suitability qualified installation agent of:
             Organisation:
             (builders / owner builder name):……………………………………………………………...
             Address:    ………………………………………………………………………………………
                         ………………………………………………………………………………………
             Phone No:………………………………………………………………………………………..
             Email address:…………………………………………………………………………………..
             Signature:………………………………………………………………………………………..
          Form No.  – Bushfire Construction Compliance Certificate 1 September 2013