Part 2: Houses in Multiple Occupation

Housing Act 2004

Part 2: Houses in Multiple Occupation Mandatory Licensing Application Form

For admin use only: Date Issued: Please return the completed form to: Date Received: Private Sector Housing Reference: Cornwall Council Dolcoath Avenue Camborne Please contact us if you need any assistance Cornwall TR14 8SX filling in the form. Email: [email protected]

Please be aware that your details will be added to a public register of licensed houses in multiple occupation within Cornwall as required by the Housing Act 2004 on granting a HMO licence. This register is available to view on Cornwall Council’s website.

Cornwall Council HMO App 2012 page 1 of 20 Please complete the following: (Fill in this form in blue or black ink and please write clearly or print)

PART 1 APPLICANTS INFORMATION PART 2 MANAGEMENT ARRANGEMENTS PART 3 DETAILS OF PROPERTY PART 4 DETAILS OF AMENITIES PART 5 DECLARATIONS

All of the following must be submitted (where required) for your application to be deemed valid Checklist:

□ Licence Fee - £490

□ Completed and signed application form □ Detailed Floor Plan with room names and sizes

□ Copy of Landlords Annual Gas Safety Certificate (if applicable)

□ Copy of Annual Fire Detection and Alarm System Testing Certificate (Required for Grade A and Grade D Fire Detection Systems)

□ Copy of Routine Testing Log of Automatic Fire Detection System (Required for Grade A and Grade D Fire Detection Systems)

□ Copy of Electrical Installation Condition Report/Periodic Inspection and Testing Certificate

□ Copy of Annual Fire Extinguisher Testing Certificate (where applicable)

□ Copy of Annual Emergency Lighting Testing Certificate (where applicable)

□ Copy of Routine Testing Log for Emergency Lighting

□ Copy of Annual Portable Appliance Testing Certificate The council will need to notify all those PART 1: APPLICANTS INFORMATION with a legal interest of its decisions with Will the applicant be the proposed licence holder? Yes No respect to the licence. Cornwall Council HMO App 2012 page 2 of 20 Please state whether you are applying for an HMO licence as:

An individual a limited company a partnership a trust

1. Address of property to be licensed: (One application per property)

……………………………………………………………………………………… Postcode ……………………………………… 2. Name & address of applicant: …………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………… Tel: ……………………………………………… Mobile: ……………………………

Email: ………………………………………………………………………………… Date of Birth: ………………

3. Name & address of owner(s) of property if different from applicant. Please specify whether leaseholder or freeholder (please use a separate sheet if necessary) The council must be ……………………………………………………………………………………………………………………… satisfied that the proposed licence ……………………………………………………………………………………………………………………… holder is a ‘fit and proper person’. …………………………………………………… Management structures and Tel: ……………………….. Email: …………………………………………………………………………………………… funding arrangements must 4. If the applicant is a company, partnership, or trust, please complete the attached be suitable. If the information in Appendix 1 of this application council are not satisfied on these 5. Name and address of mortgage company (all details must be provided for your matters then a licence may not be application to be deemed valid): awarded.

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………………………… Cornwall Council HMO App 2012 page 3 of 20 ………………………………………………………………………………………………………………………

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Mortgage account number: ……………………………………………………

6. Fit & proper person – the words below have been taken directly from the regulations within Statutory Instrument 2006 No.373 and are a fundamental requirement of this application. The mention of ‘the Act’ refers to the Housing Act 2004.

The local authority must consider evidence whether the proposed licence holder, and any person associated or formerly associated with them, whether on a personal, work or other basis is a fit and proper person.

Statement: Yes No Please indicate if there has been any unspent convictions that may be relevant to the proposed licence holder’s fitness to hold a licence and in particular any such conviction in respect of any offence involving fraud, dishonesty, violence, drugs or Sexual Offences Act 2003: Schedule 3 (a) Please indicate if there has been any finding by a court or tribunal against the proposed licence holder or manager that he/she has practised unlawful discrimination on the grounds of sex, colour, race, ethnic or national origins or disability in or in connection with, the carrying on of any business. Please indicate if there has been any contravention on the part of the proposed licence holder or manager of any provision of any enactment relating to housing, public health, environmental health or landlord and tenant law which led to civil or criminal proceedings resulting in a judgement being made against him. Please indicate if there has been any information, about any HMO or house the proposed licence holder owns or manages, which has been the subject of a control order under section 379 of the Housing Act 1985 (a) in the five years preceding the date of the application or any appropriate enforcement action as described in section 5 (2) of the Act Please indicate if there has been any HMO or house the proposed licence holder owns or manages that has been the subject of an interim or final management order under the Act. Please indicate if there has been any HMO or house the proposed licence holder owns or manages for which a local housing authority has refused to grant a licence under Part 2 or 3 of the Act:

We may require your co-operation to confirm the information we obtain. We may also have to share/and or check information with other authorities, such as the Police, Fire & Rescue Service, Office of Fair Trading, Inland Revenue etc.

Signing of this application will be taken as your agreement to any such action.

Cornwall Council HMO App 2012 page 4 of 20 7. Are you a member of any landlords association or other professional body? Yes □ No □

Please indicate which: …………………………………………………………………………………………………… The council must by Membership Number …………………………………………………………… law ask for details of other HMOs where 8. Please confirm that your building is adequately insured: Yes □ No □ licences have been granted or refused. 9. Please list other HMOs/houses in a) this local authority area b) other local authority area. (Please use separate sheet if necessary)

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10. Do you hold any professional qualifications relevant to your application? Please indicate which:

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11. Are you on any accommodation lists for any academic or other organisation/institution? Please state which.

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12. Please list any training courses you have undertaken or conferences attended in the last 3 years which you feel make you a better landlord.

Cornwall Council HMO App 2012 page 5 of 20 ………………………………………………………………………………………………………………………………………………………………………

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Cornwall Council HMO App 2012 page 6 of 20 PART 2: MANAGEMENT ARRANGEMENTS If your agent or manager does any 1. Name and address of person managing the property of the following then they must complete ……………………………………………………………………………………………………………………… the fit and proper declarations below: ………………………… Collects rent ……………………………………………………………………………………………………………………… Is the main contact for repairs ………………………… Arranges payment of bills Tel: ……………………………………… Email: ……………………………………………………………………… Terminates and renews tenancies 2. Is the manager to be the licence holder? …………………………………………………………

3. Professional qualifications such as RICS, ARMA, ARLA, etc.

……………………………………………………… Membership Number:

……………………………………………

Does the manager have professional indemnity insurance? Yes □ No □

Does the manager have a procedure for dealing with complaints? Yes □ No □

4. Please provide details regarding the management arrangements for the property. This should demonstrate competency of any individuals involved in its management, areas of responsibility, proposed visit frequencies, maintenance, inspection/testing programmes, access arrangements for Local Authority Officers and spend authorisations/funding arrangements: ……………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………

Cornwall Council HMO App 2012 page 7 of 20 ……………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………… ………………… 5. Name & full address of any manager/rent collector/ other person having control of the property (please indicate)

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Tel: ……………………………………………….. Email: …………………………………………………………………………… The council must be 6. Company/partnership/trust information: including Registered address or principal satisfied that the trading address where appropriate (where different from above) proposed managing agent is a ‘fit and ……………………………………………………………………………………………………………………… proper person’. Management ……………………………………………………………………………………………………………………… contracts must be suitable. If the …………………………………………………… council is not satisfied on these Tel: ………………………………….………………….. Email: ……………………………………………………………………. matters then a licence may not be 7. Fit & proper person – the words and details used in section 5.1 – 5.6 have been awarded. taken directly from the regulations within the Statutory Instrument 2006 No.373 and are a fundamental requirement of this application. The mention of ‘the Act’ refers to 2004 Housing Act.

The local authority must consider evidence whether the proposed licence holder, and any person associated or formerly associated with them, whether on a personal, work or other basis is a fit and proper person.

Statement: Yes No Please indicate if there has been any unspent convictions that may be relevant to the proposed licence holder’s fitness to hold a licence and in particular any such conviction in respect of any offence involving fraud, dishonesty, violence, drugs or Sexual Offences Act 2003: Schedule 3 (a) Please indicate if there has been any finding by a court or tribunal against the proposed licence holder or manager that he/she has practised unlawful discrimination on the grounds of sex, colour, race,

Cornwall Council HMO App 2012 page 8 of 20 ethnic or national origins or disability in or in connection with, the carrying on of any business. Please indicate if there has been any contravention on the part of the proposed licence holder or manager of any provision of any enactment relating to housing, public health, environmental health or landlord and tenant law which led to civil or criminal proceedings resulting in a judgement being made against him. Please indicate if there has been any information, about any HMO or house the proposed licence holder owns or manages, which has been the subject of a control order under section 379 of the Housing Act 1985 (a) in the five years preceding the date of the application or any appropriate enforcement action as described in section 5 (2) of the Act Please indicate if there has been any HMO or house the proposed licence holder owns or manages that has been the subject of an interim or final management order under the Act. Please indicate if there has been any HMO or house the proposed licence holder owns or manages for which a local housing authority has refused to grant a licence under Part 2 or 3 of the Act:

8. Please indicate number of individual properties you manage: …………………………………….

PART 3: PROPERTY DETAILS

1. Type Of Property (please tick only one of the boxes)

Shared House □ House divided into bedsits □ Self contained single unit □ Flat in multiple occupation □ A purpose built block of flats □ Hostel □ A house converted into and comprising only self contained flats □

If converted, date of conversion: …………………………………………………………………………………………  - REMEMBER Please provide the relevant building control completion certificate. WE NEED A COPY

Other □ please give details: ……………………………………………………………………………………………

For example – a mix of self contained and shared accommodation

Tenancy Type:

2. Considering the age, character and locality of the property, please state if it is/has:

Cornwall Council HMO App 2012 page 9 of 20 a) Structurally sound and in reasonable repair Yes □ No □ b) Reasonably free from damp Yes □ No □ c) Clean & in good repair Yes □ No □ d) Secure (with adequate window and external door locks) Yes □ No □ e) Adequate facilities for rubbish storage and disposal Yes □ No □

Have you a schedule for: a) Planned maintenance Yes □ No □ b) Inspection of furniture/facilities/equipment? Yes □ No □

(please provide brief details if available) ………………………………………………………………………………………………………………… ………………. ………………………………………………………………………………………………………………… ………………

Please give approximate date of original construction: circle as appropriate

Pre 1919 1919-45 1946-64 1965-80 Post 1980

3. Do you have planning approval for use as a house in multiple occupation? Yes □ No □

4. Form of structure: Detached Terraced Semi detached End terraced Grouped design Back to back terrace Wholly Residential/Residential block Commercial Elements/Mixed use block

5. Fire Precautions a) Is there a automatic fire detection system installed in the property: Yes No - A fire alarm panel Yes No

Cornwall Council HMO App 2012 page 10 of 20 - Emergency lighting covering the escape route Yes No - Smoke/heat detectors in kitchen/common rooms Yes No - Smoke detectors covering the hallways and landings Yes No - Sounders/alarms on all levels Yes No - Call points on the hallways and next to exit doors Yes No - Fire blankets in all kitchens Yes No - Fire extinguishers on all hallways and landings Yes No b) Are all the doors opening onto the main escape route 30 minute fire resistant doors incorporating self-closers? Yes No c) Are these doors fitted with smoke seals and intumescent strips? Yes No d) Is the escape route kept clear of flammable material and other obstructions? Yes □ No □ e) Do you have a contractor/s to maintain and inspect your Fire Precautions? Yes □ No □

Please state the contractor: …………………………………………………………………………  - REMEMBER f) Is there a log book of inspection/testing? Yes □ No □ WE NEED COPIES g) Where is it kept? …………………………………………………………………………………………………. h) Have the occupants been given details of fire escape routes and fire safety training? Yes □ No □ i) Has a competent person carried out a Fire Risk Assessment of the Property? (not required in “shared” type HMO

properties) Yes □ No □ Please provide a copy Even responsible landlords may encounter problems 6. Heating & Insulation with rogue traders a) What form of heating does the property have? purporting to be approved gas Gas fired central heating Yes No contractors. Off peak night storage heaters Yes No Individual wall mounted gas heaters Yes No Visit the gas safe Individual wall mounted electric heaters Yes No register online or

Cornwall Council HMO App 2012 page 11 of 20 refer to the HSE for further information. Other (please specify if there is no fixed heating system):

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Heating System Coverage:

Bedrooms Yes No Washing Facilities Yes No Hallways Yes No Communal Living Room Yes No Kitchen Yes No

Please give details of where fixed programmable heating is not provided in the property:

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Is the loft insulated? Date if known: ……………………………………. Yes No If there are cavity walls, do you have cavity wall insulation? Yes No Are the windows: In good repair? Yes No Double glazed? Yes No Does the property have a carbon monoxide detector Yes No b) If there are gas appliances, please confirm that you have a current Landlords Gas Safety Certificate (required annually for the installation and equipment you provide) and provide a copy. Yes □ No □

Cornwall Council HMO App 2012 page 12 of 20 c) Please confirm that you have an electrical installation condition report from a NICEIC approved or equivalent electrical engineer or for new build properties a commissioning certificate Please attach the most recent copy Yes □ No □

Please indicate date of any major work to the electrical installations.

Date: ……………………………………………………………………………………………………………………… d) Please confirm whether or not you provide portable electric appliances such as irons, toasters and fridges for use by tenants Yes □ No □

Please attach the most recent copy of PAT test certificate

If you are uncertain 7. Electrical Appliances and Furniture as to whether the furniture you Please indicate whether you provide: provide is safe and complies with the Furniture Yes No Furniture and Appliances (e.g. kitchen equipment, heater, vacuum cleaner) Yes No Furnishings (Fire) Is all furniture compliant with current fire safety regulations? Yes No (Safety) Are all the appliances compliant with current electrical safety Yes No Regulations, then regulations? advice is available Please forward a copy of your latest Portable Appliance Testing from Trading (PAT) certificate. Standards.

8. Tenancy Management Please confirm whether you provide the following: Tenancy agreements/written details of terms of tenancy, including Yes No sanctions for anti social behaviour? If you use a standard form of tenancy agreement, please provide a copy Inventory & schedule of condition at commencement of occupancy Yes No Rent book/receipts Yes No Repairs contact/procedure Yes No Complaints procedure Yes No  - REMEMBER WE NEED A COPY Cornwall Council HMO App 2012 page 13 of 20 9. Any further information you feel will help to demonstrate your management skills?

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PART 4: Amenity Details

Please remember to provide a detailed floor plan of the property including room size measurements (see guidance sent with this application)

Type of facility Location (Please circle floors below) Number (Total) Bath/shower Basement Ground 1st 2nd 3rd 4th Wash hand basin Basement Ground 1st 2nd 3rd 4th W.C Basement Ground 1st 2nd 3rd 4th Cooker Basement Ground 1st 2nd 3rd 4th Combination Microwave Basement Ground 1st 2nd 3rd 4th (Please note this does not include conventional microwaves) Sink & Drainer Basement Ground 1st 2nd 3rd 4th Fridges Basement Ground 1st 2nd 3rd 4th Freezers Basement Ground 1st 2nd 3rd 4th Combined Fridge Freezers Basement Ground 1st 2nd 3rd 4th Food storage cupboards Basement Ground 1st 2nd 3rd 4th

Number of sleeping rooms (bedrooms): Number of households (unrelated persons): Cornwall Council HMO App 2012 page 14 of 20 Number of people occupying the HMO:

Any other details of facilities which you consider relevant to your application:

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Cornwall Council HMO App 2012 page 15 of 20 PART 5: Declarations

IMPORTANT INFORMATION You must let certain persons know in writing that you have made this application or give them a copy of it. The persons who need to know about it are:

 Any mortgagee of the property to be licensed  Any owner of the property to which the application relates (if that is not you) i.e. the Please note that it is freeholder and any head lessors who are known to you a criminal offence to  Any other person who is a tenant or long leaseholder of the property or any part of it knowingly supply (including any flat) who is known to you other than a statutory tenant or other tenant information which is whose lease or tenancy is for less than three years (including a periodic tenancy) false or misleading  The proposed licence holder (if that is not you) for the purposes or  The proposed managing agent (if any) (if that is not you) obtaining a licence.  Any person who has agreed that he/she will be bound by any conditions in a licence if it is Evidence of any granted. statements made in You must tell each of these persons: this application with regard to the  Your name, address, telephone number and e-mail address or fax number (if any) property concerned  The name, address, telephone number and e-mail address or fax number (if any) of the may be required at proposed licence holder (if it will not be you) a later date. If we  Whether this is an application for an HMO licence under Part 2 or for a house licence subsequently under Part 3 of the Housing Act 2004 discover something  The address of the property to which the application relates which is relevant  The name and address of the local housing authority to which the application will be and which you made should have  The date the application will be submitted disclosed, or which has been incorrectly I/We declare that I/We have served a notice of this application on the following persons who are the only persons known to me/us that are required to be informed that I/We have made stated or described, this application: your licence may be cancelled or other Signed: ………………………………………………………… Date: ……………………………………………………… action taken.

Name: (please print) ………………………………………………………………………………………………………..

Signed: ………………………………………………………… Date: ………………………………………………………

Name: (please print) ………………………………………………………………………………………………………..

Cornwall Council HMO App 2012 page 16 of 20 The council will need to notify all those Please provide details of the people you have informed regarding the above. with a legal interest of its decisions with respect to the Name: ………………………………………………………………………………………………………………………. licence. Please supply details of all Address: ………………………………………………………………………………………………………………………. freehold and leasehold owners Description of the person’s interest in the property or the application: and the mortgagee. Please continue on a ……………………………………………………………………………………………………………………… separate sheet if ……………………. necessary. Date of Service: ……………………………………………………………………………………………………………. Please supply the mortgage account number so that the Name: ………………………………………………………………………………………………………………………. lender may match the council’s Address: ………………………………………………………………………………………………………………………. correspondence with Description of the person’s interest in the property or the application: the correct property.

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Date of Service: …………………………………………………………………………………………………………….

Name: ……………………………………………………………………………………………………………………….

Address: ……………………………………………………………………………………………………………………….

Description of the person’s interest in the property or the application:

……………………………………………………………………………………………………………………… …………………….

Date of Service: …………………………………………………………………………………………………………….

Cornwall Council HMO App 2012 page 17 of 20 DECLARATION

I/We declare that the information contained in this application is correct to the best of my/our knowledge. I/We understand that I/we commit an offence if I/we supply any Please note that it is information to a local housing authority in connection with any of their functions under a criminal offence to any of Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we knowingly supply know is false or misleading or am/are reckless as to whether it is false or misleading. information which is false or misleading Signed: ………………………………………………………… Date: ……………………………………………………… for the purposes or obtaining a licence. Name: (please print) ……………………………………………………………………………………………………….. Evidence of any statements made in Signed: ………………………………………………………… Date: ……………………………………………………… this application with Name: (please print) ……………………………………………………………………………………………………….. regard to the property concerned may be required at a later date. If we subsequently discover something which is relevant and which you should have disclosed, or which has been incorrectly stated or described, your licence may be revoked and/or other action taken.

Cornwall Council HMO App 2012 page 18 of 20 Appendix 1 – Details of companies, partnerships and trustees

Company/partnership/trust information: including registered address or principal trading address where appropriate: ………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………… Tel: ……………………………………………… Email: …………………………………………………………………………

Names, contact details and signature of all directors/partners/trustees (please use a separate sheet if necessary) Name: …………………………………………………… Signed: …………………………………………………… Tel: ………………………………………………..

Email:…………………………………………………………… (Director/Partner/Trustee)

Name: …………………………………………………… Signed: …………………………………………………… Tel: ………………………………………………..

Name & address of Company Secretary …………………………………………………………………………………………………………………………………………………………………

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Cornwall Council HMO App 2012 page 19 of 20 …………………………………………………………………………………………………………………………………………………………………

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Tel: ……………………………………………….. Email: …………………………………………………………………………

Details of relevant professional qualifications such as RICS, ARMA, ARLA, etc (please use a separate sheet if necessary) Pre-printed information about your organisation is acceptable, validated by the signature of the appropriate officer. (Where different from above) ………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………… Tel: ……………………….…………………………….. Email: ……………………………………………………………………

Cornwall Council HMO App 2012 page 20 of 20