Form Re 684a - Certification (Reviewed Budget)
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1S
C
tate of
alifornia
B
r
e
ureau of
eal
State
S
(R
B
)
C
uBdiviSionS
ertifiCation
eviewed
udget
dbP File NuMber
curreNt File NuMber
RE 684A (Rev. 7/16)
Subdivider
MaSter File NuMber
tract NuMber
tract NaMe
advertiSiNg NaMe
Street addreSS
city
croSS StreetS
couNty
A. File information: (Check one box and enter 2nd, 3rd, etc., and 1, 2, 3, etc., in the spaces below as appropriate.)
1.
This is a condominium project located on ________ lot(s). This is the ______ phase of a ______ phase project.
2.
The ______ phase of a ______ phase project with no additional tract maps.
3.
This is a multiple (tract) map filing, and this application covers the ______ (tract) map of ______ total single-
phase maps.
4.
This is a multiple-phase, multiple (tract) map filing, and this application covers the ______ phase of the ______
(tract) map of a total of ______ phases and ______ maps.
B. Complete the following information:
1. Number of residential units/lots in this filing: .................................................
_______________________
2. Number of buildings containing residential units in this filing: ......................
_______________________
3. Estimated completion date of residential units in this filing: ...........................
_______________________
4. Estimated completion date of common area improvements and facilities
included in this filing: ......................................................................................
_______________________
5. Common area lots (numbers/letters) in this filing: ..........................................
_______________________
____________________________________
6. Common area improvements and facilities included in this filing:
____________________________________________________________________________________________
C. The attached copy of CalBRE budget review reflects the budget for this phase was deemed acceptable by CalBRE
Special Investigator _______________________________________ on ____________________, File No.
________________________.
D. The budgets covering this subdivision are currently under review under Master File No. ________________________.
CertifiCation
I hereby certify under penalty of perjury that the above information is true and correct and that less than twenty-four months have
passed since the budget for this phase was reviewed by CalBRE or appropriate budgets are currently under review by the CalBRE.
I further certify that there have been no changes whatsoever in this phase (e.g., number of residential units/lots, common area lots,
common area improvements and facilities, etc.) or in the phasing plan and the offering is exactly as represented when the budget was
reviewed.
SigNature oF Subdivider
date
PriNted NaMe oF Subdivider
title
corPoratioN, PartNerShiP, joiNt veNture NaMe, iF aPPlicable
buSiNeSS telePhoNe No. (include area code)
buSiNeSS addreSS (Street addreSS, city, State aNd ZiP code)
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