Rental Housing Inspecton Program Registration Form

RENTAL HOUSING INSPECTON PROGRAM

REGISTRATION FORM

MAILING ADDRESS: 915 I Street, MC 20000 ● Sacramento, CA 95814

(916) 808-7368

Please complete all information below and sign where appropriate. 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 Sacramento and the annual program fee is paid. A new registration form must be submitted not later than 30 days after a change of owner,

agent or rental status. Form may be returned by mail (see mailing address above), by fax to 916-288-9955 or e-mail to

Please check one:

_____New Registration

_____New/Add Local Contact

_____Update Mailing Address/Phone Number(s)

______________________________________

________________________

Rental Property Address:

Assessor’s Parcel #:

(As shown on property tax bill or property deed)

Total Number of Rental Units:_________________________

Property Owner Name: ______________________________________________________________________________

Owner Mailing Address: ______________________________________________________________________________

Street Name/Number

City

State

Zip

Owner Phone #’s (please include area code):

(Day): ________________________

(Evening ): ________________________

(Cell): ________________________

***REGISTRATION FORMS WITHOUT A CONTACT PHONE NUMBER WILL NOT BE ACCEPTED***

Local Contact Representative- (Per Chapter 8.120, Article II of the Sacramento City Code- Must reside or conduct business within 35

miles of Sacramento City Hall, maintain a local telephone number and be authorized to accept service of all notices from the City of

Sacramento. PLEASE PROVIDE THE FOLLOWING INFORMATION:

If Same as Owner Check Here: ______

Local Contact: ____________________________________

Mailing Address: ________________________________________________________________________________

Street Address

City

State

Zip Code

Phone # (Day): _________________

Phone # (Eve): _________________

Phone # (Cell):_________________

***

Rental Unit Exemptions: 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 within is exempt from this program, please complete the Exemption and Waiver Form and return to the mailing

address listed above. Exempt categories include properties newly constructed within the last five years; Units inspected by other government or local agencies

such as Housing and Urban Development (HUD), Sacramento Housing and Redevelopment Agency (SHRA) or similar; or if the unit(s) is not a “residential

housing unit” as defined by section 8.120.030 of the Sacramento City Code.

*****************************************************************************************************************************************************************************************************

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 pursuant to Chapter 8.120, Article II of the City of Sacramento City Code.

Signature of Owner:_____________________________________ Signature of Local Contact Representative: _________________________________

Printed Name of Owner: _________________________________

Printed Name of Local Contact Representative:_______________________________

Date:_____________________________

Date:_____________________________

Rev. 5/29/2015