MARK CHURCH
EF-63-A-R04-0518-41000806-1                                                             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. Iundersttexclusfassessmenttconstruction,installation,modificatofany
   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. Thespecificportionsoftheprojectthatareeligibleforthisexclusionare:

                          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-R04-0518-41000806-2
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,ovofportturof                                                      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, 
disabled This                     exclusion modi
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 

structure more accessible to, or usable by, a disabled person. All documents necessary to support the exclusion 
rty                               Assessor      s                     ix months  after the completion of   the 
project.

Disabled person means a person who suffers from a physical impairment that substantially limits one or more of 

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.

improvem building                                                               include
modi

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 
shaltion
improvements to the building or structure to make the building or structure more accessible to, or usable by, a 
disabled person.