(REV. 8/2016) -CONTINUED ON NEXT PAGE-1 CONSUMER COMPLAINT FORM The filing of this complaint does not prohibit you from filing a civil action. Subject (Person Complaint is Against) Last Name: Suffix: Architect License Number (If Known) : C - First Name : Middle Name : Business Name: Business Address : City : State/Province : ZIP/Postal Code : Country : Email (If Known) : Business Phone : Home Phone (If Known) : Complainant (Person Making the Complaint) Last Name : Suffix: First Name : Middle Initial : Address : City : State/Province : ZIP/Postal Code : Country : Email : Daytime Phone : Evening Phone : Best Time of Day to Contact : PRIOR TO SIGNING THI S FORM , REVIEW ALL INFORMA TION. I certify and declare u nder penalty of per j ury under the la w s of the State of California that all of m y representatio n s on th i s Consumer Complaint Form (including reverse and attachments) are true, correct, and contain n o m a terial o m i ssio n s of fact to t he best of m y knowled g e and belief. If called upon, I will assist in the investigation or in the prosecution of the subject of this complaint or other involved parties, and will, if necessary, swear to a complaint, attend hearings, and testify to facts. Signature Date BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GAVIN NEWSOM, GOVERNOR DEPARTMENT OF CONSUMER AFFAIRS CALIFORNIA ARCHITECTS BOARD 2420 Del Paso Road, Suite 105, Sacramento, CA 95834 P (916) 574-7220 | F (916) 575-7283 | www.cab.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com CONSUMER COMPLAINT FORM (REV. 8/2016) -REVIEW AND SIGN ON PAGE- 2 General Information 1. What is the property address of the project? 2. Did you and the Subject sign a written agreement before any services were rendered? YES NO If YES , please attach a copy. If you do not have a written contract or agreement, please provide a detailed description of the scope of services the S ubject was to provide for this project. 3. Do you have copies of canceled checks or other evidence of payment to the S ubject? YES NO If YES , please provide copies. 4. Do you have design plans prepared by the S ubject? YES NO If YES , please provide copies. 5. What is the current status of the project ? 6. Did the building department require an architect or other licensed professional for this project? YES NO 7. Did the Subject explain the construction process and terms of the contract for services prior to starting work on the project ? YES NO 8. Indicate thy type of structure involved in this project: Single - family residential Nonresidential over 100,000 square feet Multi - unit residential Specialized structure, such as essential services buildings, hospitals, schools. Nonresidential less than 100,000 square feet 9. What is/was the estimated cost of construction for the project? 10. Have you discussed your complaint with the Subject? YES NO 11. Have you contacted an attorney regarding this matter? YES NO If YES , please completed the information below: Name: Phone Number: Address: 12. Have you filed a claim in any court regarding this complaint? YES NO If YES , please complete the information below: Name of Court: Hearing Date (if scheduled): 13. Please d escribe (on a separate sheet of paper and attach) the events which led to your complaint and specify pertinent dates, monies paid, balances owed, amounts claimed by third parties, etc. Please attach any documentation that will help support you r complaint. American LegalNet, Inc. www.FormsWorkFlow.com CONSUMER COMPLAINT FORM (REV. 8/2016) 3 Additional Information The following questions are optional; however, the California Architects Board (Board) would appreciate your cooperation in completing the questions. The information is confidential and will be used for statistical purposes to guide the Board in future decisions. 14. How did you choose the architect you hired for your project ( e.g., personal recommendation, research, phone book listing, etc. )? 15. Have you ever used the services of an architect prior to this project? N o , I have not used the services of an architect prior to this project. Yes , I have worked with the same architect on (indicate number) of past projects. Yes, I have worked with a different architect(s) on (indicate number) of past projects. 16. How many architects did you interview before you made a selection? 17. What is your occupation ? 18. prior to beginning the project? YES NO If YES , did you find the publication helpful? 19. D id you contact project? YES NO American LegalNet, Inc. www.FormsWorkFlow.com