Fill and Sign the Hazard Disclosure Form

CALIFORNIA NATURAL HAZARD DISCLOSURE STATEMENT This statement applies to the following property: _____________________________________________________________________________________________ The transferor and his or her agent(s) or a third-party consultant disclose the following information with the knowledge that even though this is not a warranty, prospective transferees may rely on this information in deciding whether and on what terms to purchase the subject property. Transferor hereby authorizes any agent(s) representing any principal(s) in this action to provide a copy of this statement to any person or entity in connection with any actual or anticipated sale of the property. The following are representations made by the transferor and his or her agent(s) based on their knowledge and maps drawn by the state and federal governments. This information is a disclosure and is not intended to be part of any contract between the transferee and transferor. THIS REAL PROPERTY LIES WITHIN THE FOLLOWING HAZARDOUS AREA(S): 1. A SPECIAL FLOOD HAZARD AREA (Any type Zone "A" or "V") designated by the Federal Emergency Management Agency. Yes _____ No _____ Do not know and information not available from local jurisdiction ____ 2. AN AREA OF POTENTIAL FLOODING shown on a dam failure inundation map pursuant to Section 8589.5 Gov’t of the Government Code. Yes _____ No _____ Do not know and information not available from local jurisdiction ____ 3. A VERY HIGH FIRE HAZARD SEVERITY ZONE pursuant to Section 51178 or 51179 of the Government Code. The owner of this property is subject to the maintenance requirements of Section 51182 of the Government Code. Yes _____ No _____ 4. A WILDLAND AREA THAT MAY CONTAIN SUBSTANTIAL FOREST FIRE RISKS AND HAZARDS pursuant to Section 4125 of the Public Resources Code. The owner of this property is subject to the maintenance requirements of Section 4291 of the Public Resources Code. Additionally, it is not the state's responsibility to provide fire protection services to any building or structure located within the wildlands unless the Department of Forestry and Fire Protection has entered into a cooperative agreement with a local agency for those purposes pursuant to Section 4142 of the Public Resources Code. Yes _____ No _____ 5. AN EARTHQUAKE FAULT ZONE pursuant to Section 2622 of the Public Resources Code. Yes _____ No _____ 6. A SEISMIC HAZARD ZONE pursuant to Section 2696 of the Public Resources Code. Yes (Landslide Zone) _____ Yes (Liquefaction Zone) _____ No _____ Map not yet released by state _____ - 1 - 7. AIRPORT INFLUENCE AREA: An expert shall determine whether the property is within an airport influence area as defined in subdivision (b) of Section 11010 Bus. & Prof. of the Business and Professions Code. Property is NOT in an Airport Influence Area Property IS in an Airport Influence Area, and the following statement applies: NOTICE OF AIRPORT IN VICINITY: This property is presently located in the vicinity of an airport, within what is known as an airport influence area. For that reason, the property may be subject to some of the annoyances or inconveniences associated with proximity to airport operations (for example: noise, vibration, or odors). Individual sensitivities to those annoyances can vary from person to person. You may wish to consider what airport annoyances, if any, are associated with the property before you complete your purchase and determine whether they are acceptable to you. * * * THESE HAZARDS MAY LIMIT YOUR ABILITY TO DEVELOP THE REAL PROPERTY, TO OBTAIN INSURANCE, OR TO RECEIVE ASSISTANCE AFTER A DISASTER. THE MAPS ON WHICH THESE DISCLOSURES ARE BASED ESTIMATE WHERE NATURAL HAZARDS EXIST. THEY ARE NOT DEFINITIVE INDICATORS OF WHETHER OR NOT A PROPERTY WILL BE AFFECTED BY A NATURAL DISASTER. TRANSFEREE(S) AND TRANSFEROR(S) MAY WISH TO OBTAIN PROFESSIONAL ADVICE REGARDING THOSE HAZARDS AND OTHER HAZARDS THAT MAY AFFECT THE PROPERTY. Transferor represents that the information herein is true and correct to the best of the transferor's knowledge as of the date signed by the transferor. Signature of Transferor(s) __________________________________ Date ________________________ Signature of Transferor(s) __________________________________ Date ________________________ Agent(s) ________________________________________________ Date ________________________ Agent(s) ________________________________________________ Date ________________________ Check only one of the following: Transferor(s) and their agent(s) represent that the information herein is true and correct to the best of their knowledge as of the date signed by the transferor(s) and agent(s). Transferor(s) and their agent(s) acknowledge that they have exercised good faith in the selection of a third-party report provider as required in Civil Code Section 1103.7, and that the representations made in this Natural Hazard Disclosure Statement are based upon information provided by the independent third-party disclosure provider as a substituted disclosure pursuant to Civil Code Section 1103.4. Neither transferor(s) nor their agent(s)(1) has independently verified the information contained in this statement and report or (2) is personally aware of any errors or inaccuracies in the information contained on the statement. This statement was prepared by the provider below: Third-Party Disclosure Provider(s) _________________________________ Date ___________________ Transferee represents that he or she has read and understands this document. Pursuant to Civil Code Section 1103.8, the representations made in this Natural Hazard Disclosure Statement do not constitute all of the transferor's or agent's disclosure obligations in this transaction. Signature of Transferee(s) ________________________________________ Date ___________________ Signature of Transferee(s) ________________________________________ Date ___________________ - 2 -