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Application for Exemption from the Rental Housing Inspection Program

  2. City, ST

    Citrus Heights, CA

    I hereby declare the following:
    I am the property owner for the property described above.

    I understand and acknowledge that pursuant to Division 3, Subdivision V of Chapter 50 of the Citrus Heights Municipal Code all rental housing properties and rental housing units are subject to routine periodic inspection by the City of Citrus Heights.

    I believe that the property noted above is/are exempt from inspection for the following reason(s):
  5. Reason for Exemption*

    Supporting documentation is required

  6. 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)
  7. Required: An inspection report, agency agreement, or proof of payment. Documentation must be current and must show the rental property address. 

  8. Not a Rental Because
  9. Address of the unit you occupy within a multiple unit dwelling / Explanation of why this is not a rental unit under CHMC 50-244.

  10. We require supporting documentation to show occupancy and will accept the following: Proof of Cable, Internet or Phone service, Voter Registration at the location. We do not accept utility bills as supporting documentation.

  11. I understand that if I engage in the business of rental housing with any non-exempt rental housing unit(s), I am required to register the property with the City of Citrus Heights Rental Housing Inspection Program and must pay any and all related fees as required by Municipal Code regardless of this request for exemption. I also understand that this request for exemption may require additional documentation confirming the basis for this exemption request.
    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.
  13. Optional:  upload any additional documentation that you believe may support your request

  14. Leave This Blank:

  15. This field is not part of the form submission.