senarai semak.ccc.osc3.0.2015

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UNIT PUSAT SETEMPAT (OSC) MAJLIS DAERAH KUALA SELANGOR45000 KUALA SELANGOR, SELANGOR DARUL EHSAN Tel : 03-3289 1439 / 3289 1549 Fax : 03-3289 338 / 3289 1101

!e"#$%e :

SENARAI SEMAKPERMOHONAN PERAKUAN SIAP & PEMATUHAN (CCC)

SENARAI SEMAK.CCC/OSC3.0/2014-pindaan/1.20151/6

MAKLUMAT PERMOHONAN :

Tajuk P!j"k P"#$an%unan & .....................................................................................................................

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

1. Na#a dan A'a#a( & .....................................................................................................................

) P"#i'ik * .......................................................................................................................

.......................................................................................................................

.......................................................................................................................

N!. Kad P"n%"na'an & .....................................................................................................................

N!. T"'"+!n/T"'. ,i#$i( & ............................................ N!. a & ........................................

2. Na#a dan A'a#a( & .....................................................................................................................

) PSP * .......................................................................................................................

.......................................................................................................................

.......................................................................................................................

N!. Kad P"n%"na'an & .....................................................................................................................

N!. T"'"+!n/T"'. ,i#$i( & ............................................ N!. a & ........................................

3. N!. ai' OSC & MKS/OSC/ ................................................................................................

4. N!. ai' K ,an%unan & .....................................................................................................................

5. Taik K"'u'uan & .....................................................................................................................P"'an ,an%unan )"nd!"*

6. Taik ,!an% , & .....................................................................................................................(Pengemukaan Borang B seterusnya Pindaan Kepada Pelan Lulus)


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Tanda(an%an dan C!pP"undin%

Taik &

** Semua borang-borang ini perlu bertaip/cetakan komputer.

Bil. BUTIR-BUTIR / DOKUMEN YANG DIPERLUKAN)Tandakan pada an% $"kai(an dan an% (idak $"kai(an*

Bil. DokumenSemkn

Pemo!on OS"

UNIT PUSAT SETEMPAT #OS"$

1.Sua( P"#!!nan k"pada OSC a$a(an Ka7a'an,an%unan dan 8AM / 8M. (endakla sama dengan

ta!uk Kelulusan Pelan Bangunan)

1

2.

Sa'inan ,!an% ,. (yang tela di cop terima ole "nit#S$ semasa permoonan masuk tapak dan diperakuisa ole PSP ). (bertaip/cetakan komputer)

2

Sa'inan ,!an% 91 : 9 21. (salinan diperakui saole PSP setiap elaian dan ditandatangani).(bertaip/cetakan komputer)

2

Si'a "(akan a'inan iji' CI, SSM dan ,!an%4; un(uk k!n(ak(! dan p"undin%.

2

3.Sa'inan ua( k"'u'uan / !k!n%an a$a(an("knika' an% $"kai(an di ,!an% 9 $"iku( !#p*

i. Fad>!pF

ii. F!+(>!pF

1

=.

,!an% : CCC P"nu

,!an% 1 : CCC S"$aa%ian 1

8a#pian OSC/SKIM.CP/2014-pindaan/1.2015

N!. PT D N!. Ru#a / a'an / Na#a Ta#an / "ni,an%unan "(a N!.Siji' ,!an% ($onto Seperti%ilampiran)

4

S"naai na#a p"#$"'i '"n%kap d"n%an na#a n!.8!(/PT n!. D a'a#a( u#a n!. T"'"+!n dana'a#a( "#aa p"#!!nan p"#$"'ian.

2

;.

Sa'inan ,!an% )a'inan P,T* 1

Sa'inan ,!an% )a'inan Aki("k/uu("a* 1

Sa'inan ,!an% )8AM / 8M* 1

N!(a &

1. S"(iap ,!an% 91 in%%a 921 an% di'a#pikan $!'" di#ua( (uun daipada 'a#an 7"$ 8"#$a%a Aki("k/ 8"#$a%a uu("a Ma'aia ((p&//777.'a#.%!@.#/>>>/+!#-%1-%21 dan "ndak'a $"(aip/>"(akank!#pu(".

%. P"n%"#ukakan &linn Bo'n( G) - G%) +!(!(a( p"'u *i+ukukn # ,+in*in(, $ ">aa '"n%kap#"n%iku( (uu(an $"#u'a daipada a'inan ,!an% , "in%%a ,!an% 921 $"a#a-a#a d"n%an ua(!k!n%an ja$a(an $"kai(an (adakan pemisa setiap borang) "$anak % &linn oo&.

3. S"#ua Bo'n( B Bo'n( G) !in(( G%) "ndak'a di #"("ai ,&linn *i0e'kui &!, dandi(anda(an%ani !'" O'n( Um Yn( Men(emukkn #PSP$.

4. Bo'n( 1 #Slinn Pi!k Be'ku& Tem0n$ dan Lm0i'n OS"/SKIM."P/%2)3-0in*n/).%2)4p"'u'a *i&in(kn )"$anak % &linn$ ("(api dik"#ukakan ""n(ak d"n%an ,!an% 9 )CCC* an%("'a di$ukukan.

5. Si'a pa(ikan n!. Sii ,!an% an% dik"#ukakan "ndak'a un(uk p"#$an%unan p"#ajuan da'a#n"%"i S"'an%! : >(. & 8AM/S/N!. ....................... dan (aik "ndak'a dik!!n%kan.
http://www.lam.gov.my/ccc/forms-g1-g21http://www.lam.gov.my/ccc/forms-g1-g21


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Ta&$'( %e&$)a : Ta*+a%a*a* / . eaa$ :

D$#e)a' .le( :

6. Si'a '"n%kapkan "'aian Lm0i'n OS"/SKIM."P/%2)3-0in*n/).%2)4 un(uk (Skim Perumaan / SkimKilang / KedaiPe!abat / Bangunan Strata) - ika $"kai(an.

UNTUK KEGUNAAN PE5ABAT #OS"$ :


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Na#a Ta#an &N!. ai' OSC &N!. ai' K, &N!. ,!an% &

Taik ,!an% &

Tajuk Pembangunan :

............................................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

BIL. NO. LOT NO. RUMAH / KEDAIPE5ABAT 65ENIS BANGUNAN

NAMA 5ALAN 6TAMAN

NO.BORANG 1

i"diakan !'"&

.................................................Tanda(an%an dan C!p Aki("k

,u(i-$u(i FOan% (a#a an% M"n%"#ukakanF )PSP* $""(a >!p.

Na#a & .............................................................................

A'a#a( & ........................................................................

N!. P"nda+(aan 8AM & ...............................................................

Taik & ...............................................................


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Na#a Ta#an & Puncak %elimaN!. ai' OSC & +%KS/#S$/PB/,/,N!. ai' K, & +%KS.0,/1/2-000N!. ,!an% & L3+/S/4o. ,,567

Taik ,!an% &

CADANGAN PEMBINAAN KEDAI PEJABAT 2 TINGKAT YANG MENGANDUNGI :a. JENIS KP 1 2!" # !$"% :

&. ' UNIT JENIS KP 1&&. 1 UNIT JENIS KP 1A&&&. 2 UNIT JENIS KP 1B&(. 1 UNIT JENIS KP 1C b.

JENIS KP 2 2)" # !$"% :&. * UNIT JENIS KP 2&&. 1 UNIT JENIS KP 2A&&&. + UNIT JENIS KP 2B

,. 1 UNIT PENCA-ANG EEKT/IKDI ATAS SEBA0AGIAN T PT 12+)3 PUNCAK DEIMA3 BANDA/ PUNCAK AAM3 MUKIM IJK3DAE/A0 KUAA SEANG/ UNTUK TETUAN KENCANA 0DINGS BE/0AD.

BIL.NO. LOT NO. RUMAH / KEDAIPE5ABAT 6

5ENIS BANGUNANNAMA 5ALAN 6

TAMANNO. BORANG

1

1. 4o. P8 06 ingga P8 0614o. 169 129 19 1,9 09 69 29 9 ,9 09 6 2.(Kedai Pe!abat 8ingkat KP (6: ; 6,:))


7/7

UNIT PUSAT SETEMPAT (OSC) MAJLIS DAERAH KUALA SELANGOR45000 KUALA SELANGOR, SELANGOR DARUL EHSAN Tel : 03-3289 1439 / 3289 1549 Fax : 03-3289 338 / 3289 1101

!e"#$%e :

JADUAL TANGGUNGJAWAB PROSES PERAKUAN BERPERINGKAT

5ENISBORANG

KOMPENEN KONTRAKTORKONTRAKTOR

TREDPRO1ESIONAL

,!an% ,Mu'a k"ja : adua'p"an>an%an k"#ajuan k"ja 7 (/$ PSP

,!an% 91 K"ja-K"ja Tana 7 (/$ SP

,!an% 92 P"#an>an%an Tanda 7 7 )uuku

Tana ,"'""n*PSP

,!an% 93 Aa Tapak 7 (/$ SP,!an% 94 S(uk(u 7 (/$ SP

,!an% 95 P"paipan Ai a'a#an (/$7 )Tukan% Paip

,"'""n*SP

,!an% 96 P"paipan Sani(ai a'a#an (/$7 )Tukan% Paip

,"'""n*SP

,!an% 9 E'"k(ika' a'a#an (/$7 )Oan% an%C"kap/Mai*

SP

,!an% 9= M"n"n(an% K"$akaan )Pai+* 7 (/$ PSP

,!an% 9; M"n"n(an% K"$akaan )Ak(i+* (/$ 7 SP

,!an% 910 P"n%udaan M"kanika' (/$ 7 SP,!an% 911 P"#aan%an 8i+ / Eka'a(! (/$ 7 SP

,!an% 912 ,an%unan 7 (/$ PSP

,!an% 913 Si("# ,"ka'an Ai 8uaan (/$ 7 SP

,!an% 914 R"(iku'ai P"#$"(un%an (/$ 7 SP

,!an% 915 8!ji Ra7a(an P"#$"(un%an (/$ 7 SP

,!an% 916Si("# ,"ka'an E'"k(ika'8uaan

(/$7 )Oan% an%C"kap/Mai*

SP

,!an% 91 a'an dan Pai( (/$ 7 SP

,!an% 91= 8a#pu a'an (/$7 )Oan% an%

C"kap/Mai*

SP

,!an% 91; Pai( 8uaan (a#a 7 7 SP

,!an% 920 T"'"k!#unikai 7 7 SP

,!an% 921 Pandan%an aa( 7 7 Aki("k/Aki("k

8andkap

NOTA :

""" : FC"(i+i>a(" O+ C!#p'"(i!n and C!#p'ian>"F ,!an% )P"akuan Siap an P"#a(uan*PSP : FPinipa' Su$#i((in% P"!nF )Oan% (a#a an% M"n%"#ukakan P"#!!nan*

GAki("k P!+"i!na' uu("a P!+"i!na' a(au P"'uki P"'an ,an%unan : )("ad k"pada 3000 kaH #aki#a*SP : FSu$#i((in% P"!nF )Oan% an% M"n%"#ukakan P"#!!nan*7 : P"'u dipa(ui / diii !'" !an% an% $"kai(an.

/+ : Tidak $"kai(an.

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