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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.
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 2020?

   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.
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.
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:


94. Submit

* indicates a required field