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RENTAL HOUSING INSPECTION PROGRAM REGISTRATION FORM

2. IMPORTANT MESSAGE
   If you have already submitted a Registration Form by mail or email within the last 12 months, DO NOT COMPLETE THIS FORM unless there are changes.

   If you have already submitted a Registration Form by mail or email within the last 12 months, DO NOT COMPLETE THIS FORM unless there are changes.

4. A complete registration form is required annually. It is unlawful for any person to engage in the business of rental housing unless this completed registration form is provided to the City of Citrus Heights, and the annual registration and Housing Stock Fees are paid. A new registration form must be submitted no later than 30 days after a change of owner, agent or rental status. One registration form is required per rental property.

6. Type of Registration*

   1. New Registration
   2. Annual or Renewal Registraton
   3. Update Contact Information
7. Did you complete this form in 2019?

   1. Yes
   2. No
   3. I don't remember
9. PROPERTY INFORMATION

11. Type of Dwelling

    1. Single-Family
    2. Duplex
    3. Triplex
    4. Fourplex
    5. Other Multi-Family
    6. Apartment Complex

12. Total Number of Rental Units for this property

14. Complex Name

16. Citrus Heights Property Address*

17. Parcel Number *

    Need Help Finding Your Parcel Number?

19. Property Manager*

    1. I manage my own property

    1. I have a Property Manager

21. **Some rental units may be exempt from this program as determined by and to the satisfaction of the Director of Code Enforcement. If you believe your property or a portion of units whithin is exempt from this program, please complete the Application for Exemption.
    Exempt categories include properties newly constructed within the last five years; units inspected by other government agencies such as Sacramento Housing and Redevelopment Agency (SHRA) or similar; or if the unit(s) is not a "residential housing unit." Complete an Application for Exemption Form at www.citrusheights.net/RHIPExemptionForm if you believe your rental unit is exempt. Supporting documentation is required.

    Exempt categories include properties newly constructed within the last five years; units inspected by other government agencies such as Sacramento Housing and Redevelopment Agency (SHRA) or similar; or if the unit(s) is not a "residential housing unit." Complete an Application for Exemption Form at www.citrusheights.net/RHIPExemptionForm if you believe your rental unit is exempt. Supporting documentation is required.

25. OWNER INFORMATION*

    Are you the Owner?

    1. I am the Property Manger Filing on behalf of the Property Owner
    2. I am the owner of the property identified by the previously listed address and APN
26. Management Agreement

    Attach a copy of the Management Agreement authorizing you to sign on behalf of the owner of the identified property.

28. Owner Name*

30. Owner Mailing Address

32. City, State

    Enter your mailing address City and State

33. Zip

35. Owner Daytime Phone #

    Registration forms without an Owner phone number will not be accepted

36. Owner Cell #

37. Owner Email Address*

41. PROPERTY MANAGER INFORMATION

    A Property Manager must be authorized to accept service of all notices from the City of Citrus Heights RHIP and be able to be present for inspections

42. Property Manager/ Contact Name

44. Property Manager Mailing Address

46. City, State

47. Zip

49. Manager Daytime Phone #

50. Manager Alternate Phone #

51. Manager Email Address

55. Tenant Information
    The following information is OPTIONAL. Tenant information is used to contact tenants prior to scheduling an inspection.

    The following information is OPTIONAL. Tenant information is used to contact tenants prior to scheduling an inspection.

57. Tenant Name

58. Tenant Address

60. Tenant Daytime Phone

61. Tenant Cell Phone

62. Tenant Email

64. Tenant Name

65. Tenant Address

67. Tenant Daytime Phone

68. Tenant Cell Phone

69. Tenant Email

71. Tenant Name

72. Tenant Address

74. Tenant Daytime Phone

75. Tenant Cell Phone

76. Tenant Email

78. Tenant Name

79. Tenant Address

81. Tenant Daytime Phone

82. Tenant Cell Phone

83. Tenant Email

87. ELECTRONIC SIGNATURE AGREEMENT*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree. Electronic Signature
89. It is unlawful for any person to knowingly make a false statement of fact or knowingly omit any information that is required to register a rental housing unit (CHMC 50-247)

91. Electronic Signature*

92. Date*
    Date

93. Receive an email copy of your submittal

Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit Submit and Print

* indicates a required field