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RHIP (RENTAL HOUSING INSPECTION PROGRAM) REGISTRATION FORM

2. 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.

4. PROPERTY INFORMATION

6. Type of Registration*

   1. New Registration

   1. Annual Registration

   1. Add or Change Property Manager

   1. Update Contact Information

8. Type of Dwelling

   1. Single-Family
   2. Duplex
   3. Condominium
   4. Fourplex
   5. Apartment Complex

9. Total Number of Rental Units

10. Total Number of Buildings

12. Citrus Heights Property Address*

13. Parcel Number *

    Need Help Finding Your Parcel Number?

15. Property Manager*

    1. I manage my own property

    1. I have a Property Manager

17. **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 ano a "residential housing unit." Complete an Application for Exemption Form if you believe your rental unit is exempt. Supporting documentation may be required. **

21. OWNER INFORMATION

23. 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

24. Management Agreement

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

26. First Name*

27. Last Name

29. Owner Mailing Address*

31. City*

32. State*

33. Zip*

35. Daytime Phone #*

    Registration forms without a complete contact phone number will not be accepted

36. Evening Phone #

37. Cell #

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

43. Mailing Address

45. City

46. State

47. Zip

49. Property Manager/ Contact Name

50. Daytime Phone #

51. Alternate Phone #

55. 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

57. 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)

59. Electronic Signature*

60. Date*
    Date

61. Reply Email

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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field