CALIFORNIA NATURAL HAZARD DISCLOSURE STATEMENT
This Natural Hazard Disclosure Statement concerns the real property situated in the City of ________________
_________, County of ______________________ , State of California, described as:
This Statement is a disclosure of natural hazards relating to the above described property in compliance with
section 1102 of the California Civil Code. It is not a warranty of any kind by the seller(s) in this transaction, and
is not a substitute for any inspections or warranties the buyers may wish to obtain.
This Natural Hazard Disclosure Statement is made pursuant to Section 1102 of the Civil Code. Other statutes may
require disclosures, depending upon the details of the particular real estate transaction (for example: special study
zone and purchase-money liens on residential property). In addition, there may be local disclosure requirements
in your particular city or county.
The Seller discloses 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 based on their knowledge and maps drawn by the estate and
federal governments. 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.
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 re 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
denitive 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 Sellers knowledge as of the date
signed by the Seller.
Signature of Seller _____________________ Date ________
Buyer represents that he or she has read and understands this document.
Signature of Buyer _____________________ Date ________
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