35755 F21

Page 2

4. Details of the building development approval

 Building development approval number


 Building certifier reference number             35755


5. Performance standards
If the building work uses a performance-based solution, list the performance requirements used.

 Performance requirements




6. Certification
Pursuant to section 10 of the Building Act 1975 for the performance of building certification functions.

 I certify that on an inspection carried out in accordance with best industry practice, the building work for the above building or
 structure was inspected and complies with the building approval or certificates of inspection were accepted from competent
 persons at the following stages of the construction.



                                               Date of inspection                         Date of certificate
 Foundation / footing stage                    4/05/2022                                  4/05/2022
 slab stage                                    4/05/2022                                  4/05/2022
 Frame Stage                                   8/08/2022
 Final stage                                   28/03/2023
 Other stages
 Blockwork/Masonry stage




 Dated this             29/03/2023



7. Building certifier

 Name (in full)                        Michael Bowcock

 Company name (if applicable)          Coastal Building Certifications P/L

 Contact person                        Michael Bowcock

 Business phone number                 07 5476 9988                                 Mobile     0414954390

 Email address                         [email protected]

 Licence number                        A23659




Building Act 1975 • Section 98 and 99 • Form 21 • Version 1 • September 2021                                              Page 2 of 4

Page 3

8. Signature of building certifier for the work




    Signature                                                                                        Date     29/03/2023




LOCAL GOVERNMENT USE ONLY

    Date received                      Click or tap to enter a date.     Reference number/s




Appendix – explanatory information
Who can complete and sign a Form 21? (section 99(2) of the Building Act 1975)
The relevant building certifier must complete and sign the Form 21 for the purpose of stating the work is certified compliant with
the building development approval.
The building certifier is required to attach to this form, all relevant inspection documentation that has been relied on by the
building certifier to certify the building work complies with the building development approval. Inspection documentation, for
inspection of building work, means the following documents given for the building work:
•     a compliance certificate
•     a notice, given to the builder for the work by or for the building certifier about an inspection of the work
•     a certificate about an inspection under this Act
•     a final inspection certificate
•     a certificate of occupancy
•     a certificate relating to the inspection of the building work relied on by the relevant building certifier


Examples of the above documents are the Form 16 – Inspection certificate, 43 – Aspect certificate (QBCC licensee) and 12
– Aspect inspection certificate (appointed competent person).
Visit the Business Queensland website for all approved and administrative building forms published by the department.
When is a Form 21 issued? (section 99 of the Building Act 1975)
If the building certifier is satisfied the final stage of building work complies with the building development approval and the
inspection was carried out under industry best practice, that the work complies with the building development approval, they
must within the required period give the Form 21 and the inspection documentation to the owner. The required period means
the period that ends five business days after:
•     accepting all the inspection documentation relied on by the building certifier, or
•     all of the building work has been inspected.
Giving inspection documents to the relevant local government (section 149 of the Building Act 1975)
A private certifier must give the relevant local government copies of all inspection documentation within five business days after
one of the following happens:
•     the giving of the final inspection certificate for the building work or a certificate of occupancy for the relevant building
•     the discontinuance of the engagement of the private certifier
•     the lapsing of the building development approval; in these circumstances the certifier must also give the local government a
      copy of the relevant reminder notice issued under section 95 of the Building Act.
However, if the inspection documentation includes certificates relied on by the certifier, the five business days do not start until
after the certifier has accepted all the certificates.
Note: under section 150 of the Building Act the building certifier must keep all inspection documentation for at least seven
years.
Competent person (section 10 of the Building Act 1975 and Part 6 of the BR 2021)
A building certifier must assess and decide to appoint an individual as a competent person before they can, as a competent
person, give design-specification help. The building certifier is required to keep detailed records about what was considered
when appointing a competent person.




Building Act 1975 • Section 98 and 99 • Form 21 • Version 1 • September 2021                                                    Page 3 of 4

Page 4

A competent person cannot give inspection help to a building certifier until they have been appointed by the building certifier.
For further information about assessment of someone as a competent person refer to the Guideline for the assessment of
competent persons.
Under section 36 of the Building Regulation 2021 the building certifier must record the details of their decision making to appoint
a competent person and keep this record for at least 7 years. A maximum 20 penalty units apply for each offence committed
under this provision.
Inspection help (section 34 of the BR 2021)
A building certifier must be satisfied that an individual is competent to give the type of inspection help having regard to the
individual’s experience, qualifications and skills and if required by law to hold a licence or registration, that the individual is
appropriately registered or licensed.
For further information about conducting inspections for class 2 to 9 buildings, refer to the Guideline for inspection of class 2
to 9 buildings.
For further information about conducting inspections for detached class 1a and 10 buildings or structures refer to the Guideline
for inspections of class 1 and 10 buildings and structures.


PRIVACY NOTICE
The Department of Energy and Public Works is collecting personal information as required under the Building Act 1975. This
information may be stored by the Department, and will be used for administration, compliance, statistical research and
evaluation of building laws. Your personal information will be disclosed to other government agencies, local government
authorities and third parties for purposes relating to administering and monitoring compliance with the Building Act 1975.
Personal information will otherwise only be disclosed to third parties with your consent or unless authorised or required by law.




Building Act 1975 • Section 98 and 99 • Form 21 • Version 1 • September 2021                                                   Page 4 of 4