Name *

Position *

Company Name *

Address *

City *

Zip *

Phone Number *

Fax Number

E-Mail *

II. Property Information

Name of Property

Type of Property *
Commercial Industrial Residential Public

Address of Property *

City *

Zip

Building Square Feet *

Site / Total Square Feet *

Year Built *

Number of Stories *

Number of Parking Spaces *

Number of Accessible Parking Spaces *

Are tenant improvements planned in the near future?
yes Select one yes no

Was a complaint filed against your property by an aggrieved individual for failure to comply with disabled access regulations?
yes Select one yes no

Is the City Building Department requiring Disabled Access Compliance?
yes Select one yes no

Are you interested in a Compliance Survey & Report as a good faith effort?
yes Select one yes no

Do you have an 8 1/2" x 11" site plan of this property?
yes Select one yes no

Please check the type of Proposal you are requesting

Select one yes no ADA / CA Title 24 Disabled Access Compliance Survey & Report