Complaint Form

Your Information

Name *

Email *

Address

City

Zip Code

Contact Phone *

Project Details

Name

Address1

City

Zip Code

Jurisdiction (Bldg. Dept.)

Permit #

Type of Work

Is the work in progress

Yes

Involved Parties in Your Complaint

Involved Rating Company

Name

Company

Address

City

Zip Code

Certification #

Office Phone

Involved Homeowner

Name

Address

City

Zip Code

Phone

Involved Builder

Name

Company

Address

City

Zip Code

Office Phone

Involved Installer

Name

Company

Address1

City

Zip Code

C.S.L.B. #

Office Phone

Complaint Details

Complete Description of alleged violation(s). Please provide as much detail as possible including dates, locations, parties involved, specific sections of code that have been violated, etc. *

Have you contacted the parties to this Complaint?

Yes

If yes, what was the response?

Complete list of all the facts documenting the complaint. You may be called upon to provide copies (not originals) of any related documents.

Explain how you obtained copies of any related information of documentation.

Suggested Resolution

Additional Information

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Complaint Form

Your Information

Project Details

Involved Parties in Your Complaint

Involved Rating Company

Involved Homeowner

Involved Builder

Involved Installer

Complaint Details

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