MARK CHURCH
EF-64-R10-0211-41000432-1                                                                            Assessor - County Clerk - Recorder
BOE-64 (P1) REV. 10 (0 -1 )2 1                                                                       555 County Center
CLAIM FOR SEISMIC SAFETY CONSTRUCTION                                                                Redwood City, CA 94063
                                                                                                     P 650.363.4500    F 650.599.7435
EXCLUSION FROM ASSESSMENT                                                                            email assessor@smcacre.org
This  claim  must  be  filed  with  the Assessor  prior  to,  or  within  30  days  of,              web www.smcacre.org
completion of construction.

     CLAIMANT NAME AND MAILING ADDRESS                                                               FOR ASSESSOR’S USE ONLY
     (Make necessary corrections to the printed name and mailing address)
                                                                                                     DATE RECEIVED
                                                                                                     APPROVED           DENIED
                                                                                                     REASON FOR DENIAL

CLAIMANT’S NAME (PLEASE PRINT)                                                                       ASSESSOR’S PARCEL NUMBER

STREET ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)                                      CITY                                   ZIP CODE

DATE (OR ANTICIPATED DATE) OF COMPLETION           DAYTIME TELEPHONE NUMBER             EMAIL ADDRESS
                                                   (          )
 YES             NO            The property owner, primary contractor, civil or structural engineer, or architect has certified to the 
                               building department those portions of the project that are seismic retrofitting components, as defined 
                               by Revenue and Taxation Code section 74.5(b)(2). 

Section 74.5 of the Revenue and Taxation Code excludes from assessment that portion of an existing structure that consists of the 
construction and reconstruction of seismic components.
In order to receive the exclusion, this claim form must be filed with the assessor prior to, or within 30 days of, completion of the project. 
All documents necessary to support the exclusion must be filed with the Assessor by the property owner not later than six months after 
completion of the project.
The property owner, primary contractor, civil or structural engineer, or architect shall certify to the building department those portions 
of the project that are seismic retrofitting components, as defined by Revenue and Taxation Code section 74.5(b)(2). Upon completion 
of the project, the building department shall report to the Assessor the costs of the portions of the project that are seismic retrofitting 
components.
For purposes of section 74.5
(1)  “Seismic retrofitting components” means seismic retrofitting improvements and improvements utilizing earthquake hazard mitigation 
 technologies.
(2)  “Seismic retrofitting improvements” means retrofitting or reconstruction of an existing building or structure, to abate falling hazards 
 from structural or nonstructural components of any building or structure including, but not limited to, parapets, appendages, cornices, 
 hanging objects, and building cladding that pose serious danger. “Seismic retrofitting improvements” also means either structural 
 strengthening or providing the means necessary to resist seismic force levels that would otherwise be experienced by an existing 
 building or structure during an earthquake, so as to significantly reduce hazards to life and safety while also providing for the substantially 
 safe ingress and egress of building occupants during and immediately after an earthquake. “Seismic retrofitting improvements” does 
 not include alterations, such as new plumbing, electrical, or other added finishing materials, made in addition to seismic-related work 
 performed on an existing structure. “Seismic retrofitting” includes, but is not limited to, those items referenced in Appendix Chapters 
 5 and 6 of the Uniform Code for Building Conservation of the International Conference of Building Officials.
(3)  “Improvements utilizing earthquake hazard mitigation technologies” means improvements to existing buildings identified by a local 
 government as being hazardous to life in the event of an earthquake. These improvements shall involve strategies for earthquake 
 protection of structures. These improvements shall use technologies such as those referenced in Part 2 (commencing with Section 
 101) of Title 24 of the California Building Code and similar seismic provisions in the Uniform Building Code.
                               THIS EXCLUSION EXPIRES UPON CHANGE IN OWNERSHIP OF THE PROPERTY.
                                                                         CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, 
including any accompanying statements or documents, is true, correct and complete to the best of my knowledge and belief.
SIGNATURE OF PERSON MAKING CLAIM                                                                                      DATE
t
                                 THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION