2. Rental Housing Business License and Inspection Program - Self Certification Application

   The following information is required for self-certification for compliance with the City of Hesperia’s Rental Housing ordinance. Please use one form per multi-family or single-family rental property.

4. PLEASE USE ALL CAPS FOR YOUR RESPONSES
6. Rental Property Information
8. Please complete all fields and enter N/A if not applicable.
10. Number of Units in Rental Property*
11. Complex Name*
13. Street Address*

    You have multiple rental units at this property.

14. City*
15. State*
16. Zip Code*
18. Street Address*

    You have one (1) rental unit at this property

19. City*
20. State*
21. Zip Code*
23. Are you an owner or the manager of this property? *

    1. Owner
    2. Manager
    3. I am both the owner and the manager
25. Applicant is required to provide contact information in the event that the City must follow up for additional information.
27. Applicant Name*
28. Applicant Email*
29. Applicant Phone*
33. Upload Self-Certification Affidavit *
34. Affidavit (continued)
36. Affidavit (cont.)
37. Affidavit (cont.)
38. Affidavit (cont.)
42. Upload Self-Certification Interior/Exterior Inspection Checklist*

    If property contains more than 10 units, please scan and email checklist to rentalhousing@cityofhesperia.us. Please include property address in the subject line of the email.

43. Checklist (continued)
45. Checklist (cont.)
46. Checklist (cont.)
47. Checklist (cont.)
48. Checklist (cont.)
52. Provide photographs showing the full frontage and full rear of the property, side yards, parking areas, common areas, etc.
54. Image
55. Image
56. Image
57. Image
59. Image
60. Image
61. Image
62. Image
64. Image
65. Image
66. Image
67. Image
69. Image
70. Image
71. Image
72. Image
74. Image
75. Image
76. Image
77. Image
79. Provide photographs of the interior where corrections are needed.
81. Image
82. Image
83. Image
84. Image
86. Image
87. Image
88. Image
89. Image
91. I declare under penalty of perjury that the foregoing is true and correct to my knowledge.*

    Please sign with your name

Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field