This statement applies to the following property:
_______________________________________________________
The seller and his or her agent(s) disclose the following information with the knowledge that even though this is not a warranty, prospective buyers may rely on this information in deciding whether and on what terms to purchase the subject property. Seller 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 seller and his or her agent(s) based on their knowledge and maps drawn by the state. This information is a disclosure and is not intended to be part of any contract between the buyer and seller.
THIS REAL PROPERTY LIES WITHIN THE FOLLOWING HAZARDOUS AREA(S):
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 _________
AN AREA OF POTENTIAL FLOODING shown on a dam failure inundation map pursuant to Section 8589.5 of the Government Code.
Yes _____ No _____ Do not know and information not available from local
jurisdiction _________
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 _____
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 _____
AN EARTHQUAKE FAULT ZONE pursuant to Section 2622 of the Public Resources Code.
Yes _____ No _____
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 ________
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. BUYER(S) AND SELLER(S) MAY
WISH TO OBTAIN PROFESSIONAL ADVICE REGARDING THOSE HAZARDS AND OTHER HAZARDS
THAT MAY AFFECT THE PROPERTY.
Seller represents that the information herein is true and correct to the best of the seller's knowledge as of the date signed by the seller.
Signature of Seller ____________________ Date _______________
Agent represents that the information herein is true and correct to the best of the agent's knowledge as of the date signed by the agent.
Signature of Agent ____________________ Date _______________
Signature of Agent ____________________ Date _______________
Buyer represents that he or she has read and understands this document.
Signature of Buyer ____________________ Date _______________
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