Form Rp-10 - Property Owner'S Statement Form - Assessor Los Angeles County
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1
2Property Owner’s Statement
New Construction
JEFFREY PRANG
ASSESSOR
ASSESSOR’S IDENTIFICATION NUMBER
Run No.
Use Code
Region
Cluster
Permit Date
Permit No.
Permit Information
Address Correction Requested
For assistance, call M-F 8 a.m. - 5 p.m.
Complete and return to Assessor by:
Permit Address
I M P O R T A N T
This form MUST be filed within 40 days. Our records indicate a building permit was issued for new construction on your property. Please complete and return this
form. Include any documentation you believe to be important to our valuation of your new construction. Revenue and Taxation 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 or her property...”
Completion Date
Contractor’s Name
(Estimate if not complete)
Did you do any of the work yourself?
Contractor’s Phone
License Number
If yes, specify in Remarks
o
o
Yes
No
section on reverse side.
Instructions: Please check appropriate boxes below, providing costs where requested. Describe new construction and materials used
in Remarks Section on reverse side. “Total Cost” is the amount paid or spent for completed work, including labor and materials.
2 Heating/Air Conditioning
N = New Unit
R = Replacement Unit
1 Type of Construction
N
R
o
New Building (Specify :_________________________ )
o o
$___________
Central Air Conditioning
o
Addition to Main Structure
o o
$___________
Fireplace
o
Alteration
o o
$___________
Forced Air Furnace
o
Pool or Spa
o o
$___________
Heat Pump
o
Other (Describe: ______________________________)
o o
$___________
Solar Cooling or Heating
Total Sq. Ft. of New Structure or Addition ___________
o o
$___________
Wall Heater
(See Item 7 for Area Computation)
o o
$___________
Other _________________
Total Cost
Total Cost
$___________
$___________
3 Plumbing Items
4 Cabinets/Appliances/Electrical
N = New Unit R = Replacement Unit
N = New Unit
R = Replacement Unit
N
R
N
R
Number
___
o o
Bath Tub
$___________
o o
$___________
Cabinets
___
o o
$___________
o o
$___________
Shower Stall
Dishwasher
___
o o
Sink
$___________
o o
$___________
Microwave (built-in)
___
o o
Solar Water Heating
$___________
o o
$___________
Oven
___
o o
Toilet
$___________
o o
$___________
Range
___
o o
Water Heater
$___________
o o
$___________
Range and Oven
___
o o
$___________
o o
$___________
Other _________________
Other _________________
Total Cost
$___________
Total Cost
$___________
5 Pool
6 Self-Contained Spa or Hot Tub
o
o
o
Type:
Fiberglass
Gunite
Plastic Lined
o
o
Type:
Gunite
Fiberglass
Size________________
o
o
o
o
Heater:
Electric
Natural Gas
Solar
o
Redwood
Other
Type:
o
o
o
Diving Board
Pool Sweep
Slide
Detail:
o
o
Type:
Permanent
Portable
Approximate Sq. Ft. of Decking _____ x ______ = _______
o
o
o
o
o
Finish:
Cement
Other__________________
Heater:
Electric
Natural Gas
Solar
o
Spa:
Attached
Total Cost
$___________
Total Cost
$___________
“Valuing People and Property”
RP-10 (FRONT) (REV. 12-14)
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