TABORA GARDENS SENIOR APARTMENTS

SENIOR 1-BEDROOM, 1-BATH APARTMENTS

CURRENTLY ACCEPTING APPLICATIONS FOR:

62 AND OVER VETERANS and/or
62 AND OVER PERSONS WITH HIV/AIDS
RENT IS 30% OF INCOME

PLEASE FILL OUT THE ATTACHED APPLICATION AND MAIL IT TO:

HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA
ATTN: PBV PROGRAM
2870 HOWE ROAD, MARTINEZ, CA 94553

LOCATED AT 3701 TABORA DRIVE (AT JAMES DONLON BLVD)

ANTIOCH, CA 94509

• Meditation area • Extensive grounds/3.2 acre site

• Raised bed gardening • Nearby open space reserve
• 5 laundry rooms • On-site resident services and
• Exercise room property management
• Activity room with computers

We will accept applications on first come first serve basis.

The deadline to submit all applications is March 30th, 2018.
 HOUSING AUTHORITY
OF THE
COUNTY OF CONTRA COSTA

APPLICATION FOR PBV SITE-BASED WAITING LISTS

The Housing Authority of the County of Contra Costa (HACCC) is accepting applications for Project-Based
Voucher (PBV) site-based wait lists. PBV units provide families with a housing opportunity where the
assistance is tied to the unit you live in. After twelve months of consecutive residency in a PBV unit, you may
be eligible for continued tenant-based rental assistance subject to availability and your lease agreement. If you
are on the tenant-based Housing Choice Voucher wait list, placement on the PBV site-based wait lists DOES
NOT CHANGE YOUR PLACE ON THE HCVP WAIT LIST FOR A VOUCHER. If you are interested in this
opportunity, please complete the questions below and indicate what properties you are interested in on the
next page. NOTE: Some properties have resident restrictions as indicated. Check only the properties
you are interested in AND you qualify for.
1. I am interested in being on a PBV site-based wait list Yes No

2. Name of Head of Household: ________________________________________________________________

3. Current Address:
Address City State Zip
4. Telephone #: Secondary/Mobile

5. Email Address:

6. Do you or any household member live, work or have you been hired to work in Contra Costa County?
Yes No

7. Race: White African American Asian Native American Pacific Islander Other

8. Ethnicity: Hispanic or Latino Not Hispanic or Latino

9. Please list all household members who will live in the assisted unit including yourself:

Name SSN Date Of Birth M/F

Please continue on the other side if you need additional space

10. Estimated Household Unit Bedroom Size: (Circle) 1 2 3 4 5 6

11. How much is your estimated combined household annual income before taxes? $

12. Are you disabled? Yes No

If yes, check one of the following boxes: - Physical Mental Developmental HIV/AIDS

Vision Hearing

13. Do you qualify for the State’s Multifamily Housing Program (MHP) Supportive Housing or Special Needs programs?
Yes No

These Programs are State Programs to assist Special Needs Populations, including but not limited to individuals with:

• Long-term chronic health conditions that qualify for programs such as MSSP, IHSS, or PACE
• HIV/AIDS
• Mental Illness
• Physical or orthopedic disability

14. Have you been involuntarily displaced from housing due to a Federal or State declared disaster or government action
(e.g., code enforcement, public improvement or development, witness protection program)? Yes No

15. Have you graduated from an approved transitional housing program that partner’s with the Housing Authority
of Contra Costa County (HACCC), such as Shelter Plus Care? Yes No

16. If you are employed, what City do you work or were recently hired to work in: ___________________________

(CONTINUED)

2870 Howe Rd., Martinez, CA94553 Phone (925) 957-7001Fax (925) 957-1280 TDD (925) 957-1685
contracostahousing.org
17. Have you previously been terminated from the Housing Authority of the County of Contra Costa HCV Program due to
insufficient program funds? Yes No

18. Are you Homeless or At Risk of Homelessness? Yes No

19. Are you a Veteran or surviving spouse of a Veteran? Yes No

20. If you are not interested in any of the sites listed below, would you be interested in being placed on project-based
voucher site-based wait lists in the future for a new property? Yes No

Applicant Signature Date

Place an " X" in the far right column next to the properties you
want to live in AND meet the property restrictions.
Housing Authority of the County of Contra Costa Project-Based Voucher Unit Inventory

Yes,
Add Me
PROPERTY 0 1 2 3 TOTAL To This
ADDRESS PROPERTY RESTRICTIONS Wait
NAME BR BR BR BR UNITS
List -
"X"

Family Housing, some homeless

Lakeside 1897 Oakmead Dr., and disabled units, some disabled
Apartments Concord, CA X X X 30 / some HIV/AIDS

Brentwood
Senior 750 Larkspur Lane,
Apartments Brentwood, CA X 79 Over 62 Yrs Old

Samara Terrace 102 Civic Dr, Hercules,

Apartments CA X 51 Over 62 Yrs Old

Acalanes Court 1988 Trinity Ave,

Apartments Walnut Creek, CA X X 4 Family Housing

Hookston Senior 80 West Hookston Rd.,

Homes Pleasant Hill, CA X X 24 Over 62 Yrs Old

Giant Road 2832 Giant Rd., San

Apartments Pablo, CA 94806 X X X 21 Family Housing

Lafayette
Senior/Belle 3428 Mt. Diablo Blvd, Over 62 Yrs. Old, 17 Verifiably
Terre Apartments Lafayette, CA X 45 Disabled Units

Orinda Senior 2 Irwin Place, Orinda,

Apartments CA X 66 Over 62 Yrs. Old

Frail elderly (over 62 Yrs Old),

Berrellesa Palms 310 Berrellesa St., Some units for disabled with
Apartments Martinez, CA X 48 HIV/AIDS

Riley Court 2050-2060 Riley Ct., Family Housing, Some units for
Apartments Concord, CA X X 15 disabled with HIV/AIDS

Tabora Gardens 3701 James Donlon Over 62 Yrs. Old, Veterans,

Apartments Blvd., Antioch, CA X 34 HOPWA

Third Avenue 3rd Ave. & Baldwin St., Family Housing, Some for
Apartments Walnut Creek, CA X X X 29 developmentally disabled

Hana Gardens 10860 San Pablo Ave.,

Apartments El Cerrito, CA X 62 Over 62 Yrs. Old

Robin Lane 2050-2060 Riley Ct., Family Housing, Some units for
Apartments Concord, CA X X 8 disabled with HIV/AIDS

(CONTINUED)
2870 Howe Rd., Martinez, CA94553 Phone (925) 957-7001Fax (925) 957-1280 TDD (925) 957-1685
contracostahousing.org
 Yes,
Add Me
PROPERTY 0 1 2 3 TOTAL To This
ADDRESS PROPERTY RESTRICTIONS Wait
NAME BR BR BR BR UNITS
List -
"X"

Garden Park 3701 James Donlon

Apartments Blvd., Antioch, CA X X 27 Over 62 Yrs. Old, Disabled

1515 & 1716-1738

Riviera Family
Riviera St., Walnut
Apartments Creek, CA X X X X 18 Family Housing

Elaine Null 3rd Ave. & Baldwin St., Family Housing, Some for N/A
Apartments Walnut Creek, CA X 4 developmentally disabled

THIS FORM MUST BE RETURNED TO THE FOLLOWING ADDRESS:

HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA

ATTN: PBV PROGRAM
2870 HOWE ROAD
MARTINEZ, CA 94553

2870 Howe Rd., Martinez, CA94553 Phone (925) 957-7001Fax (925) 957-1280 TDD (925) 957-1685
contracostahousing.org