MARK CHURCH
EF-63-A-R04-0518-41000807-1                                                             Assessor - County Clerk - Recorder
BOE-63-A (FRONT) REV.   (4 05 1- 8)                                                     555 County Center
CLAIM FOR DISABLED ACCESSIBILITY CONSTRUCTION                                           Redwood City, CA 94063
EXCLUSION FROM ASSESSMENT FOR ADA COMPLIANCE                                            P 650.363.4500    F 650.599.7435
                                                                                        email assessor@smcacre.org
                                                                                        web www.smcacre.org
THIS FORM MUST BE FILED WITH THE ASSESSOR
PRIOR TO, OR WITHIN 30 DAYS OF, COMPLETION
                 OF CONSTRUCTION.

 CLAIMANT NAME                                          ASSESSOR’S PARCEL NUMBER                         PERMIT NUMBER

 ADDRESS OF DWELLING - STREET                  CITY                                        STATE            ZIP

 MAILING ADDRESS - STREET                      CITY                                        STATE           ZIP

                                               STATEMENTS

1. As the owner of the property described herein, I completed, or will complete, construction on this property on
                                                        , and therefore claim the construction exclusion from assessment 
   provided by section 74.6 of the California Revenue and Taxation Code.

2. I understand this exclusion from assessment is applicable only to the construction, installation, removal or modification of any
   portion or structural component of an existing building or structure to the extent that it is done for the purpose of making the
   existing building or structure more accessible to, or more usable by, a disabled person.

3. I further understand this exclusion does not encompass the exclusion provided by Revenue and  Taxation Code
   section 74.3 for owner-occupied residences and does not apply to the construction of an entirely new building or structure, or
   to the construction of an entirely new addition to an existing building or structure.

4. The specific portions of the project that are eligible for this exclusion are:

                          THIS EXCLUSION EXPIRES UPON CHANGE OF OWNERSHIP OF THE PROPERTY
                                               CERTIFICATION
                               I certify (or declare) under penalty of perjury under the laws of the State of California 
                                    that the foregoing statements are true and correct.
tSIGNATURE OF CLAIMANT OR LEGAL REPRESENTATIVE                                   DATE

tSIGNATURE OF CLAIMANT OR LEGAL REPRESENTATIVE                                   DATE

MAILING ADDRESS                                                                  DAYTIME PHONE NUMBER
                                                                                        (  )
CITY, STATE, ZIP                                                                 E-MAIL ADDRESS

   THE OWNER MUST SUBMIT ALL DOCUMENTS SUPPORTING THIS CLAIM TO                                  FOR ASSESSOR’S USE ONLY
   THE ASSESSOR NO LATER THAN SIX MONTHS AFTER THE COMPLETION DATE                               RECEIVED  
                                    STATED IN #1 ABOVE.                                          APPROVED 
                                                                                                 DENIED  
                                                                                               REASON FOR DENIAL

   THIS CLAIM IS A PUBLIC DOCUMENT AND IS SUBJECT TO PUBLIC INSPECTION.

EF-63-A-R04-0518-41000807-2
BOE-63-A (BACK) REV.   (4 05 1- 8)

                                          GENERAL INFORMATION

Section 74.6 of the California  Revenue  and  Taxation Code excludes  from assessment the construction, 
installation, removal or modification of any portion or structural component of an existing building or structure to 
the extent that is done for the purpose of making the building or structure more accessible to, or more usable by, 
a disabled person. This exclusion applies to any construction, installation, removal, or modification completed 
on or after June 7, 1994.

In order to receive the exclusion, the property owner shall notify the Assessor prior to, or within 30 days of, the 
completion of the project that he or she intends to claim the exclusion for improvements making the building or 
structure more accessible to, or usable by, a disabled person. All documents necessary to support the exclusion 
shall be filed by the property owner with the Assessor not later than s ix months   after the completion o   f t he 
project.

For purposes of section 74.6:

Disabled person means a person who suffers from a physical impairment that substantially limits one or more of 
that person’s major life activities.

This exclusion shall apply to existing buildings or structures except for those buildings or structures that qualify 
for the exclusion provided for in subdivision (a) of section 74.3.

The construction, improvement, modification, or alteration of an existing building or structure may include, but 
is not limited to, access ramps, widening of doorways and hallways, barrier removal, access modifications to 
restroom facilities, elevators, and any other accessibility modification of a building or structure that would cause 
it to meet or exceed the accessibility standards of the 1990 Americans with Disabilities Act (Public Law 101-336) 
and the most recent edition to the California Building Standards Code that is in effect on the date of the application 
for a building permit.

The exclusion provided for in this section does not apply to the construction of an entirely new building or 
structure, or to the construction of an entirely new addition to an existing building or structure.

The property owner, primary contractor, civil engineer, or architect shall submit to the Assessor a statement that 
shall identify those specific portions of the project that constitute construction, installation, removal, or modification 
improvements to the building or structure to make the building or structure more accessible to, or usable by, a 
disabled person.