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San Rafael

Building Division
Disabled Access Complaint Form

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Don C. Jeppson, A.I.A Chief Building Official

Office: (415) 485-3367
Inspection Line: (415) 485-3365

building@cityofsanrafael.org
Do not email Inspection Requests

1400 Fifth Avenue, Top Floor
San Rafael, CA 94901

For complete schedule information, please go here: https://www.cityofsanrafael.org/cdd_schedule/

Schedule a virtual meeting:
https://www.cityofsanrafael.org/virtual-counter/
<a href="https://www.cityofsanrafael.org/virtual-counter/">Schedule a virtual meeting:</a>

Disabled Access Complaint Form

If you are unable to complete the form online due to disabilities, please contact the Building and Safety Division at (415) 485-3086 for assistance with your complaint.

* Indicates Response Required
Complaint Location * Required
Complainant's Name * Required
First Last
Complainant's Email * Required
Complainant's Address * Required
Street Address Address Line 2 City ZIP / Postal Code
Complainant's Phone
Property Owner's Name (if known)
Property Owner's Address (if know)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Property Owner's Phone (if known)
Description of Complaint * Required
Complaint Type(s) * Required
- Path of travel (CBC 1114B.1.2)
- Parking (CBC 1129B)
- Curb ramps (CBC 1127B.5)
- Stairways (CBC 1133B.4)
- Ramps (CBC 1133B.5)
- Access to toilets (CBC 1115B.7)
- Walks & sidewalks (CBC 1133B.7)
- Doors (CBC 1133B.2)
- Entrances & exits (CBC 1133B.1)
- Telephones (CBC 1117B.2.1)
- Water fountains (CBC 1117B.1.1)
- Elevators (CBC 1116B.1)
- Signs (CBC 1117B.5)
- Other
Detailed Location(s) * Required
Confidentiality Notice
To the extent permitted by law, the City will not disclose the identity of the complainant to members of the public or in response to Public Records Act requests or subpoenas.

City of San Rafael Community Development Department
Building and Safety Division 1400 Fifth Avenue
San Rafael, CA, 94901
Tel. (415) 485-3367, FAX (415) 485-3184

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City Hall
1400 Fifth Avenue
San Rafael, CA 94901
Hours: 8:30 a.m. - 5:00 p.m.
Monday-Friday

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