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    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):
  4. Reason for Exemption*
  5. Please note: If this is an owner occupied property you are not required to pay the annual RHIP fees.
  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. Please attach documentation of routine inspections by a similar governmental agency such as an agency agreement or copy of the last payment voucher. Documentation must be current and must show the rental property address
  8. Not a Rental Because
  9. Provide the address of the unit you occupy within a multiple unit dwelling. Or provide explanation of why this is not a rental unit under CHMC 50-244.
  10. We require supporting documentation and will accept the following: Cable Bill, Phone bill, Voter Registration. We do not accept utility bills as supporting documentation for Exemption.
  11. Please provide the name and contact information for the new owner:
  12. 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 the RHIP 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.
  14. Option to upload any documentation that believe may support your request
  15. Leave This Blank:

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