SAMPLE OWNER SURVEY
CONFIDENTIAL HOMEOWNER SURVEY
Protected from Disclosure Pursuant to California Evidence Code Section 1119, et seq.
PLEASE INSPECT YOUR HOME CAREFULLY BEFORE RESPONDING. CLEAR PRESENTATION OF OUR CLAIMS DEPENDS ON ACCURATE RESPONSES.
Please take the time to review the questions below, make a visual inspection of the inside and outside of your unit, and complete the confidential questionnaire promptly and with as much detailed information as you can. If you have pictures of the problems you describe or invoices regarding clean-up or repair work, please provide copies of such documentation.
Home: ____________________ Work: ________
Fax:______________________ Email: ________
Home: ___________________ Work: ________
Fax:_____________________ Email: ________
BACKGROUND YES NO
(a) Are you the owner of the home? ______ ______
(b) Did you purchase the home from the developer? ______ ______
(c) When did you purchase the home? ____________________________________________________
(d) How long have you occupied the home? _________________________________________________
(a) Have you had any repairs to your home or have you hired a contractor or repair person do so?
If so, please describe the type of repairs made and when they were made. Please also forward all documents and photographs related to the repair work to this office.
(b) Have you contacted the developer or its agent concerning any problems with the home?
If so, please describe the type of repairs made, if any, and when they were made. Please also forward all documents and photographs related to the repair work to this office.
Please provide any other information or observation you have concerning any existing or potential construction concerns or deficiencies either below, or attach a separate sheet.