Form Submission Complete

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*
14. City*
15. State*
16. Zip Code*
18. Are you an owner or the manager of this property? *

    1. Owner
    2. Manager
    3. I am both the owner and the manager
20. Applicant is required to provide contact information in the event that the City must follow up for additional information.
22. Applicant Name*
23. Applicant Email*
24. Applicant Phone*
26. Upload Self-Certification Affidavit *
28. Provide photographs showing the full frontage and full rear of the property.
30. Image
31. Image
33. Provide photographs of the interior where corrections are needed (if applicable).
35. Image
36. Image
37. Image
38. Image
40. I declare under penalty of perjury that the foregoing is true and correct to my knowledge.*

    Please sign with your name

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field