Response Petition Civil Harassment Workplace ViolenceCal. Super. - 6th Dist.January 20, 2021Response to Request for Civil Harassment Restraining Orders Clerk stamps 53...? - when form is filed. Use this form to respond to the Request (form CH-100) . Read How Can I Respond 1‘0 a Requesz‘for Civil Harassment Restraining Orders? (fonn CH-l 20-INFO) t0 protect your rights. - Fill out this form and take it to the court clerk. . Have someone age 18 or oIder-not you-serve the person in (D or his 0r her lawyer by mail with a copy ofthis form and any attached pages. (Useform CH-250, ProofofService 0f Response by Mail.) Person Seeking Protection Full name ofp rson seeking protection (seeform CH-100. i!em©}: Merv, es Mal rem Person From Woom ProteMOn ls Sought Fill in court name and street address: Superior Court of California, County of Superior Courta Your Name 6N SI 0V]T8 g Your Lawyer ('fyou ithve onefo: this case) Name: State Bar No.: Firm Name: EM! Division 191 N. Flrstt Sfi San Jose, BA 951W b. Your Address (Ifyou have a lawyer, give your lawyer ’s information. Kyou do n0! have a lawyer and want to keep your home address privare, you may give a a’fle: em mailing address instead. You d0 no! Z] CHOO qg‘ .4 have lo give (elephone fat, 0r e- mai!.) Address: \%53 NM AGIEld. AUQUUQ #9 City: 36m fioge State:CaCA Zipzfisfig Telephone: (4085\411. (0qu Fax: E-mail Address: ® l] Personal Conduct Orders a. D l agree to the orders requested. b. E I do not agree to the orders requested. (Specifil why you disagree in item® 0n page 3.) Court fih‘s in case number when form is filed. Case Number: Present your response and any opposition at the hearing. Write your hearing date, time, and place from form CH-l 09 item ©here: nearing a Date: 3 [0H 90:1] Timefl zoom Date Dept: LL- Room: If you were served with a Temporary Restraining Order, you must obey it until the hearing. At the hearing, the court may make orders against you that last for up t0 five years. .-- c. D l agree t0 the following orders {Specify below 0r in item® onpage 3.) ® D Stay-Away Orders a. D Iagreetothe orders requested. b. E I d0 not agree t0 the orders requested. (Specrfi) whyyou disagree in item® Olzpage 3.) c. D l agree t0 the following orders (specifii below 0r in ilem® Olzpage 3): U Additional Protected Persons Nm 21. fl l agree that the persons listed in item ©ofform CH-IOO may be protected by the order requested. b. D l do not agree that the persons listed in item @of form CH-IOO may be protected by the order requested. M931 C°”"‘”‘°'Ca"'°‘"‘a-W-mm'ca-W Response to Request for Civil Harassment CH-120. Page 1 0’4Rewsed January 1, 2018. Mandaiory Form Codaorcwnprocadure,§§527.63nd527.9 Restraining Orders -9 (Civil Harassment Prevention) Case Number: ‘ZICH OOCIBFF ® Guns or Other Firearms and Ammunition Ifyou were served with form CH-l 10, Temporary Restraining Order, you cannot own or possess any guns, other firearms, 0r ammunitiorl. (See item ® ofform CH-llO.) You must sell t0 or store with a licensed gun dealer, 0r turn in t0 a law enforcement agency, any guns 0r other firearms in your immediate possession 0r control within 24 hours of being served with form CH-IIO. You must file a receipt with the court. You may use f0rm CH-SOO, ProofofFirearms Turned In, Sold or Stored, for the receipt. a. w I do not own or control any guns 0r firearms. b. D I ask for an exemption from the firearms prohibition under Code OfCivil Procedure section 527.9(0 because canying a firearm is a condition ofmy employment, and my employer is unable to reassign me to another position where a fireaml is unnecessary. (Explain): D Check here ifthere is no! enough space belowfor your answer. Put your complete answer 0n an attached sheer ofpaper and write “Alrachmem 6b-Firearms Surrender Exempiion " as a title. You may useform MC-025, Attachment c. D I have turned in my guns and firearms to the police 0r sold them to or stored them with a licensed gun dealer. A copy ofthe receipt D is attached. D has already been filed with the court. ® D Possession and Protection of Animals N/A a. lj I agree to the orders requested. b. D I do not agree to the orders requested. (Specyfll why you disagree in item® Olipage 3.) c. D I agree to the following orders (specifi/ below or in item® 0n page 3): D Other Orders a. D I agree to the orders requested. b. E I d0 not agree t0 the orders requested. (Specifiz why you disagree in item ® onpage 3.) c. D I agree t0 the following orders (specifii below 0r in item® onpage 3): ® D Denial l did not do anything described in item® of fonn CH-lOO. (Skip to® .) RevisedJam’a’y “2°15 Response to Request for Civil Harassment CH-120: P399 2 0” Restraining Orders 9 (Civil Harassment Prevention) ”2”"("5Hooqgwr D Justification or Excuse IfI did some or all ofthe things that the person in® has accused me of, my actions werejustified or excused for the following reasons (explain): D Check here I'fthere is nor enough space belowfor your answer. Pur your complele answer 0n an attached sheaf ofpaper and write “Arrac/zment I O-Jztsa'fication or Excuse " as a title. You may useform MC-025, Attachment. S‘ee cv'rirachmen’r lo Abtshficahon or este \dnd‘p; D Reasons l Do Not Agree to the Orders Requested Explain your answers (0 each order requested {hat you donor agree with. D Check here ifr/zer e is n01 enough space belowfor yam answer Pu! yow compleIe answez 0n an attached sheet ofpaper and wrire 'Allac/mzem IJ-Reasons I Disag: ee 'as a title You may useform MC-025 Attachment. 1: do noJr agree, wiirh (my o¥ We orders reau cslved because Iam Hoe, Sew, care ovom'oler For mw mom ‘ernam éonmlez. (,0th Mercede’s door‘ +0 door D&mh born Mu Mom is a 65 .‘Ill l A Al III .II I' ?ll rmmohfim Knee, réo aymem «mam Duo +0 3 l. " -0.“ ' Iol gt ¢- I‘ 1' DJ loll . 4’ ’ _ n”WW: a .. - (mnrook r er 5M? is ?Jrilh" rmfloamh’nqd‘ndn a \e . .‘n‘l‘ A’ I" _| ' ’ I- '1‘. L.'l .‘ 1.1 4_ ’4u' 'n.- n unmmm u; _.; u . p __ o e ' I _ Ill ._| g m» .1 Autfa’ \’J'MFL u“.¢_u£_o-_. QWM-mem- mm 0mm Jxer maueqlr ‘18 mHmaPm/m AM \nm- mpnmnk HmPC ’ro r/omnw mm p mmmunml poigrieg \olm- Chg; Ornh-Hmlpq mxldnlvhé Came a(%nng fin; {g MAC ‘1 A ll u . . ‘ l' I l II. n m hr? Ccrweh mr nnenq miirmmjjg. [fisn < p ii mamm mm; imam chm: um“ +'th siJmahon because, flow Earn Jncfi- [madamrk-o care, Gor her. RMWWW-m‘a Response to Request for Civil Harassment CH 120- Page 3 0’4 Restraining Orders "'9 (Civil Harassment Prevention) Case N Zlémfi'boqan ® D- No Fee for Filing a. X I request that I not be required to pay the filing fee because the person in®claims in form CH-IOO item @to be entitled t0 free filing. b. E I request thatI not be required t0 pay the filing fee because I am eligible for a fee waiver. (Form FW-OO], Request t0 Waive Court Fees, must befiled separ'aIe/y.) ® D Lawyer's Fees and Costs a, D I ask the court to order payment ofmy D Lawyer’s fees D Conn costs, The amounts requested are: I_te_l_n ~ Am ount “fl Amount $ $ $ $ S $ D Check here there are more items. Put the items and amounts on the attached sheet ofpaper and wrire “Attaclunem 13-Lawyer '5 Fees and Costs ”for a title. You may use orform MC-025, Attachment. b. D I ask the court to deny the request ofthe person asking for protection that I pay his 0r her lawyer’s fees and costs. Number of pages attached to this form, ifany: Date: Lawyer’s name (ifany) Lawyer’s signature I declare under penalty ofperjury under the laws ofthe State 0f California that the information above and on all attachments is true and correct. Date: 3'] Z! 2,021 "DAM Momm y ngx/g/ Ign y0y2/r /Type orlprinr your name 2ame Revlseddanuawmow Response to Request for Civil Harassment CH-120- Page 4 0M Restraining Orders (Civil Harassment Prevention) SHORT TITLE: - Machmem Iomwmfim Magma 11 Cwoq‘a” Wm gauge Mercaedas NA mplaeai Hue 3me she PreviOUSlEf tamov th new Hume firm ware b\odcmfifiw emfl Mg (w mom‘s menAm opens @mflm/aram D“ 30mm (9! 9333\va W30 m3: weWr C 0 m » pm MWWW \WWW 0m [\Keprcezfies waysgfi i mpg Jag)? 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Page Form Approved by me _ ADDITIONAL PAGE Judiciamouncflof California Attach to Judicial Council Form or Other Court Paper CRC 201-501 M0020 [New JanuaJy 1. 1987] MC-030 ATTORN EY OR PARTY WITHOUT ATTORNEY (Name, Stare Bar number, and address): FOR COURT USE ONLY TELEPHONE N0: FAX NO‘ (Opn'onal): E-MAIL ADDRESS (Optional): ATTORNEY FOR {Name}: SUPERIOR COURT OF CALIFORNIA. COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND LP CODE: BRANCH NAME: PLAINTIFFIPETITIONER: DEFENDANTIRESPONDENT: CASE NUMBER: DECLARATION Z] CH DDQ%\:I’ L bonsai Mw‘aas Aware, Haw I waver harms \MYQEABS WWW m WW W0~\A~ “E WA OMLQ Spoke er \och omfivm m regardfi *1) her bkoobmgmc 6W} mgr. | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) D Attorney for D Pfaintiff D Petitioner D Defendant D Respondent D Other (Specify): Form Approved for Optional Use DECLARATION Page 1 0H Judicial Council of Cahfornia M0030 [Rev. January 1, 2006] Xiomara Gonzalez 1853 Midfield Avenue APT 1 San Jose. CA 95122 January 14, 2021 San Jose Apartments 1500 Cunningham Avenue San Jose, CA 95122 Re: Blocking of exit doorway of apartment 1853#1 To: San Jose Apartments Management. I am writing to formally request your help in dealing with an issue that has been ongoing with my neighbors in (1853# 3) To date, the following actions have been taken: o On several occasions I have talked to my neighbor to resolve the issue about her blocking my exit from my apartment the doorway is facing each other with minimum space of no more that 3 or 4 feet in between. She has previously blocked the way out by putting shopping cars right in form of my door. She has also put a line of planter right in the middle of the way. 1n other occasions she has block the exits by putting a table in the middle of the way. a | have also complained to San Jose Apartment Office Manager and none of these previous attempts to resolve the problem have been successful, and this issue is directly affecting me because | am a handicap person. I use a cane and had recently kne‘e- replacement surgery and I am unable bend my knees orjump over objects. In addition is it a fire hazard to block the exits of an apartment or building according to fire ordinances. To resolve this issue I would like you to get In touch with (Mercedes Mairena resident m 1853 # 3 and facilitate a resolution I'm hoping we can resolve this issue as soon as possible. l appreciate you_r attention t6 this issue. Kindly, WWW Xiomara Gonzalez 1853#1 ARTHRITIS AND ORTHOPEDIC MEDICAL CLINIC 22] Ii Hacienda Ave Suite A. Campbell. CA 95008-6225 Tcl: (408) 356-0444 Fax: (408) 358-5 [25 sjorthodocs.com ROBERT G. AP'I‘EKAR M.D. MICHAEL D. BUTCHER. MDV DALJEE’I‘ S. SAGOO‘ D.0 Board Certified, Orthopedic Surgery Board Certified. Orthopedic Surgeij' Board Cem‘flad. O/‘(lzopedic Surgery Patient name: Gonzalez, Xiomara C January 28, 2021 Date of Birth: 03/10/1956 Address: 1853 MIDFIELD AVE APT l, SAN JOSE CA 95122-2336 Home Phone: 408-417-6093 T0 whom it may concern: This letter is t0 confilm that Daysi Montes is the primary caregiver for our patient Xiomara Gonzalez, as she listed as the emergency contact and has been attending appointments with the patient. Patient requires assistance since undergoing left total knee replacement surgery 011 September 4, 2020 and is still working towards gaining full strength, flexibility, and range of motion. If you have any question in this regard, please do not hesitate t0 call me. Sincerely, WIW Daljeet S Sagoo, D.O. Home I Service Menu | <r. if”: , m I EEdit Patient - [Patient ID: 103058345] 1 > ' Palxcni ID; 103053345 Lkbt Namu GONZALEZ l’ubl Name‘ XIOMARA E Middle Name.- r‘ Ml: C DOB - Apr. 03/10/1956 - 64 yrs. 1U mos. old Sn: F Pal. Acct, No; Accounl Type Primary Insured‘Guaranon v SSI-J‘ P . C . .mm?” mp Relemng Pumas], Ancour-I Slums: Acme v n Prowder' ch: Pawn. Rcsmrammy Bsiancc. , qD‘; not mm! Edlmg Siammunts Patient Data Insurance DocumentsPayments Appolntmonts Visit History Template Health Rocords Upcomlng Ap pointmcms: Select Aciians > Past Appointments: [No upcomMg appointment records lor this @tient Dam ?ir-n‘; L¨l Ftuxkiurszwé f.) Lu Haunt" I'D: stiv, Sums DJ“: €135 “'{g'fz'gé’f’ 05:00 pm 30 m:ns CHAQJUNG Hsu, PhD, PT GOLDEN HILLS ORTHo 3. SPORTS PT INC PT TREATMENT v.51: Created $333232”; 05-00 pm 30 mms CHAOJUNG HSu. pno‘ Pr GOLDEN HrLLs ORIHO a spams FT mo pT TREATMENT wen Cream ?;?ggsgg 05w: pm 30 m‘ms CHAOJUNG Hsu, PhD. 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Ft-Help | FZ-Add New Appointmentl F7-Adu Now ‘lisiif FE-Add Nev: Payment l FQ-Add New Palieml FSO-Patfiem Lisl WarningPiease. select row C) 2021 OfficeAlIy.com WEBA14 4 . 30 .5 Report Date; 112312821 Page: 1 GOLDEN HILLS ORTHO & SPORTS PT, INC 2680 S WHITE RD SUITE 200 SAN JOSE, CA 95148-2074 408-274-0888 Upcoming Appointments Patient: XlOMARA _C GONZALEZ Date Time Duration Reason For Visit Office Office Address Provider Status Wednesday 5:00 PM 3O mins PT TREATMENT GOLDEN HILLS 2680 S WHITE RD SUITE 200 CHAO-JUNG HSU, PhD, Active 021032021 ORTHO & SPORTS SAN JOSE, CA 95148-2074 PT PT INC Wednesday 5:00 PM 3O mins PT TREATMENT GOLDEN HILLS 2680 S WHITE RD SUITE 200 CHAO-JUNG HSU, PhD, Active 02/10/2021 ORTHO 8: SPORTS SAN JOSE, CA 95148-2074 PT PT INC Wednesday 5:00 PM 30 mins PT TREATMENT GOLDEN HILLS 2680 S WHITE RD SUITE 200 CHAO-JUNG HSU, PhD. Active 02H 712021 ORTHO & SPORTS SAN JOSE, CA 95148-2074 PT PT INC Wednesday 5:00 PM 30 mins PT TREATMENT GOLDEN HILLS 2680 S WHITE RD SUITE 200 CHAO-JUNG HSU. PhD. Active 02/24/2021 ORTHO & SPORTS SAN JOSE, CA 95148-2074 PT PT INC Wednesday 5:00 PM 30 mins PT TREATMENT GOLDEN HILLS 2680 S WHITE RD SUITE 200 CHAO-JUNG HSU, PhD, Active 03/03/2021 ORTHO & SPORTS SAN JOSE, CA 95148-2074 PT PT INC hit} ._ ,. @3®_ E amazon qo '\§/ 34°; ...n 40mg “prime . . Ieflfivered taday ‘L nfi'v‘i v“! I'I'J‘Dmfo u‘l u \- I.l V'ILTI" o lb It was great [DU Not so great :- _:'__ T." :THZTLfb'-HLTT_T_ ”Z. ': "-1: I;- :fi ‘" "HZ- :‘-W'| Delivery by Amazon Tracking .ID: TBA1 24496280804 A . _ \ \ L » U fl . v \ L . N .v ‘ ‘ 4 . 5 « me A . , / 3 % . ? / 5 . . - A J 1!!) 4 , mmmm 5J3“, M-_--..4p_-.u's. .. mm“... . , 1 _ . ‘ < , _ . \ H : . , w.. . “ “L . . < w 4 . “ n . . rw . .. ¢ 4~. Cer. ;M ( . , . . t“ 5 A . ‘ ‘ _ . ._ _. _ . . mp" r ~ . . ‘L @ f . _ _ .H 5H , . w H _ 4 - E . .1 T . . L .. _ . . 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