USE CODE COUNTY OF RIVERSIDE OFFICE OF ASSESSOR PROPERTY OWNER'S STATEMENT ON NEW CONSTRUCTION ASSESSOR'S PARCEL NUMBER Owner's Name and Mailing Address Property Situs Date Sent: Our records indicate a building permit was issued for the above situs. Please complete this form and return it to the Office of the Assessor within 3 weeks of the date shown above. Also include any additional information you believe important in evaluating the new construction Owner's Name Permit Date Permit Information Completion Date Estimated date if not complete Permit Number Owner-builder Yes Contractor Contractor Address City Zip Telephone No (Please complete below) Please Check Where Appropriate 1. STRUCTURAL CHANGES a).....Addition..........................Square feet (complete items, 3, 3a & 4) b).....Alteration........................Added Square feet (complete items 3, 3a & 4) c).....Patio................................Square feet (complete items 3, 3a & 4) d).....Pool or Spa.....................(complete item 2 or 2a) e).....Other .............................Square feet (complete items 3, 3a & 4) Please explain...................................................... ............................................................................. TOTAL COST OF WORK (Labor and Material) $............................. 2.....POOL/SPA Type) ....... Gunite ........ Fiberglass ....... Plastic Lined Size) ..................... Heater) ..... Gas ..... Solar ...... None Pool Sweep) ..... Yes ..... No Decking).......................... Approximate square feet Spa) .....Attached ..... Detached ..... None 2a.....SELF-CONTAINED SPA ONLY Type) ....... Gunite ........ Fiberglass ..... In ground ........ Above ground Size) ............................. Heater) .....Gas .....Electric TOTAL COST OF WORK FOR ABOVE $.................. TOTAL COST OF WORK FOR ABOVE $................................ 3....INTERIOR DETAIL Floors) ...... Tile ...... Carpet ...... Vinyl ...... Concrete ...... Wood ....... Other.................................................................... Walls) ...... Drywall ....... Paneling .......... Plaster ....... Other .......................................................................................... Plumbing .....1/2 Bath ..... 3/4 Bath ...... Full Bath Remarks:........................................................................................................................................................................................... 3a....EXTERIOR DETAIL Walls) ..... Stucco ..... Siding ..... Brick ..... Other ........................................................................................................ Roof Covering) ..... Clay Tile ..... Concrete Tile .... Composition Shingle ..... Wood Shingle ..... Gravel or Rock ...... Composition Roll ..... Lattice ..... Other .. Remarks ........................................................................................................................................................................................ Please Complete Reverse Side American LegalNet, Inc. www.FormsWorkFlow.com ACR 749 (Rev. 04/2009) Available in Alternate Formats 4. SKETCH OF NEW CONSTRUCTION Make a sketch of the "new construction" showing its dimensions and position in relation to any structure. Area Computation ................. * ................ = ................... ................. * ................ = ................... ................. * ................ = ................... ................. * ................ = ................... Total Square Feet = ................... Sketch example 16' 12' New Patio 32' New Room Addition Existing Residence Existing Garage Street Street PLEASE COMPLETE BELOW The Assessor's Office may audit this statement for completeness and accuracy and may contact you for additional information as required. Signature of owner or agent Date Title (agent) Address City, State & Zip Telephone Number (8am - 5pm) RIVERSIDE (Downtown) 4080 Lemon Street 1st Floor P.O. Box 12004 Riverside, CA 92502-2204 (951) 955-6200 Monday through Friday 8 AM ­ 4:30 PM HEMET 880 North State Street Hemet, CA 92543-1496 (951) 766-2500 Monday through Friday 8 AM - 12 PM & 1 PM - 4 PM TEMECULA 41002 County Center Drive, #230 Temecula, CA 92591-6027 (951) 600-6200 Monday through Friday 8 AM - 4 PM BLYTHE 270 N. Broadway Blythe, CA 92225-1608 (760) 921-5050 Monday and Wednesday 8 AM - 12 PM & 1 PM - 4 PM RIVERSIDE (Gateway) 2720 Gateway Drive Riverside, CA 92502-0751 (951) 486-7000 Monday through Friday 8 AM ­ 4:30 PM ACR 749 (Rev. 04/2009) Available in Alternate Formats American LegalNet, Inc. www.FormsWorkFlow.com