Architectural Change Request Form

Name:	Date:

Address:

Phone:	E-mail:

Description of Improvements:

Pictures of proposed materials attached

Contractor information including license # and insurance attached

I will assume the responsibility for any work under the above proposed improvement that I or my contractor accomplish, which may, in the future adversely affect the common area. I will assume responsibility for all future maintenance of this addition or improvement.

Homeowner Signature

The undersigned adjacent homeowners have no objection to the proposed improvements:

Unit #:	Signature:

Unit #:	Signature:

NOTICE TO OWNERS: Your proposed improvements may require a permit from the building department. You or your contractor should check with the building department about permit requirements before starting any work. No work should be done which may change the existing drainage patterns.

Date of Board Approval:

Board Member Signature:

***Please return this form to La Costa Hills HOA***

3475 Caminito Sierra

Carlsbad, CA 92009

Phone 760.978.9609

Fax 760.230.5878

chris@millsmanagementservices.com

Christy

2015-12-24

Chris Mills