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.

Owner: _________________________________________________________________________________

Address:________________________________________________________________________________

Telephone: 

 

Home: ____________________     Work: ________

Fax:______________________      Email: ________

Occupant: _______________________________________________________________________________

Address:________________________________________________________________________________ 

 

Telephone: 

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?     _________________________________________________

HOME REPAIRS                                                    

(a) Have you had any repairs to your home or have you hired a contractor or repair person do so?                                                                           

                                                                                YES                                NO                                                                              

                                                                              ______                           ______

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?                                                               

                                                                                YES                                NO      

                                                                              ______                           ______

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.

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Sample Homeowner Survey

ADDITIONAL COMMENTS

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.

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