OFFICE OF THE ASSESSOR-RECORDER PHIL TING SAN FRANCISCO ASSESSOR-RECORDER Assessor’s Parcel Number: PROPERTY OWNER’S STATEMENT ON NEW CONSTRUCTION PROPERTY ADDRESS (if different from mailing address) JOB DESCRIPTION Our records indicate a building permit was issued for the property identified above. The State of California’s Revenue and Code, Section 441(d), reads in part: “At any time as required by the Assessor for assessment purposes, every person shall make available for examination, information or records regarding his property.” Please complete this form and return it within 15 days of receipt to the office of the Assessor-Recorder in the enclosed envelope. If you need assistance, please call (415) 554-5596. OWNER’S NAME (check box if owner-builder) CONTRACTOR TELEPHONE APPLICATION No. PERMIT NO. DATE CONTRACTOR’S ADDRESS COMPLETION DATE (estimate if not yet completed) PERCENT NOW COMPLETED TOTAL COST OF PROJECT AMOUNT EXPENDED TO DATE PLEASE CHECK APPROPRIATE BOXES 1. Total SQ. FT. on new structure or addition (See item No. 7 for area computations) 3. 2. STRUCTURAL CHANGES NEW STRUCTURE ADDITION ALTERATION REPAIR OTHER – please explain on reverse side PLUMBING ITEMS (N=New Unit, R=Replacement Unit) N R Number TOILET BATH TUB STALL SHOWER SINK DISHWASHER WATER HEATER OTHER City Hall Office: 1 Dr. Carlton B. Goodlett Place Room 190, San Francisco, CA 94102-4698 Tel: (415) 554-5516 Fax: (415) 554-7915 www.sfgov.org/assessor e-mail: assessor@sfgov.org HEATING/AIR CONDITIONING (N=New Unit, R=Replacement Unit) N R CENTRAL AIR CONDITIONING THRU-WALL AIR CONDITIONING FORCED AIR FURNACE FLOOR OR GRAVITY FURNACE WALL HEATER OTHER 4. CABINETS, APPLICANCES, ELECTRICAL (N=New Unit, R=Replacement Unit) N R RANGE OVEN CABINETS OTHER BUILT-IN sq. ft. Business Personal Property: 875 Stevenson Street Room 100, San Francisco, CA 94103 Tel: (415) 554-5531 Fax: (415) 554-5544 American LegalNet, Inc. www.USCourtForms.com 5. WALLS: STUCCO CONCRETE BLOCK BRICK SIDING OTHER 7. 6. EXTERIOR DETAIL ROOF COVERING: TAR & GRAVEL COMPOSITION SHINGLE ASPHALT SHINGLE WOOD SHINGLE OTHER INTERIOR DETAIL FLOOR: CONCRETE HARDWOOD CARPET WALL TO WALL TITLE OTHER DIAGRAM OF NEW CONSTRUCTION (see sample sketch) Diagram the new construction and show its exterior dimensions and location in relation to other buildings on the lot. Please note that copies of your plans are not always provided to this office by other agencies. WALLS: DRYWALL PANELING PLASTER OTHER SAMPLE SKETCH --------30------New Room Addition | 20 | | Existing House Existing Garage AREA COMPUTATION OF NEW CONSTRUCTION 30 x 20 = 600 AREA COMPUTATION OF NEW CONSTRUCTION: X = X = X = X = X = X = X = X = TOTAL SQ. FT.: = ROOM COUNT: If addition of remodel, indicate main residence’s total number of rooms after completion: # of rooms Living Room Kitchen Dining Room Family/Den Bedrooms Bathrooms Other The Assessor’s Office may audit this statement for completeness and accuracy and may contact you for additional information as required. I certify that the foregoing is true, correct, and complete to the best of my knowledge. Signature of Owner or Agent City Hall Office: 1 Dr. Carlton B. Goodlett Place Room 190, San Francisco, CA 94102-4698 Tel: (415) 554-5516 Fax: (415) 554-7915 www.sfgov.org/assessor e-mail: assessor@sfgov.org Telephone No. Date Business Personal Property: 875 Stevenson Street Room 100, San Francisco, CA 94103 Tel: (415) 554-5531 Fax: (415) 554-5544 American LegalNet, Inc. www.USCourtForms.com