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CITY OF SANTA MONICA CITY PLANNING DIVISION Building

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Page 1
Occupancy Permit Application For
Occupancy of Property Following
Withdrawal Pursuant to the Ellis Act
Rev. 7/09
CITY OF SANTA MONICA – CITY PLANNING DIVISION
Building Design, Colors, Materials, and Landscape Plans
This part to be completed by City staff
Application Number(s)
Filing Date:
Fee: $
Receipt#: __________________
Received by: __________________
Once a property has been withdrawn from the rental market under the procedures set forth in Government Code Sections
7060 et seq., there are specific requirements that must be met in order for the property to be subsequently occupied. The
Planning Division is responsible for reviewing and acting upon occupancy applications. Any interested party can appeal
the Planning Division’s decision to the Planning Commission, and then to the City Council, in accordance with Subchapter
9.04.20 Part 9.04.20.24 of the Santa Monica Zoning Ordinance. Appeal forms can be obtained at the City Planning
counter.
**REQUIRED FILING MATERIAL: PROVIDE A COPY OF THE GRANT DEED FOR SUBJECT PROPERTY**
PART 1 GENERAL INFORMATION
PROPERTY ADDRESS: ________ _______
Land Use Element District:_________________Zoning District: ______________ _______
Legal Description (Lot, Block, Tract) _______
APPLICANT
Name: _______
Address: Phone: _______
Email: _______
PROPERTY OWNER
Name: _______
Address: Phone: _______
Email: _______
ATTORNEY
Name: _______
Address: Phone: _______
Email: _______
OCCUPANCY PERMIT APPLICATION
FOR OCCUPANCY OF PROPERTY FOLLOWING
WITHDRAWAL PURSUANT TO THE ELLIS ACT
Page 2
Occupancy Permit Application For
Occupancy of Property Following
Withdrawal Pursuant to the Ellis Act
Rev. 7/09
PART 2 WITHDRAWAL COMPLETE
RENT CONTROL BOARD CERTIFICATION (staff use only)
Date of withdrawal
Date of withdrawal
Title
Date Signed
PART 3 SITE CHARACTERISTICS
Number of Existing
Units:
Number of Units at site prior to exercise
of Ellis Act:
Number of Studio
Units:
1-BR Units:
2-BR Units:
3-BR Units:
4-BR Units:
5+BR Units:
Number of Units at site to remain if intended use is approved:
List unit size(s):
Number of Parking
Spaces:
Existing
Standard
Compact
Tandem
Proposed
Standard
Compact
Tandem
Description of all intended on-site uses. Include description of any units to remain vacant:
If the existing structure(s) will be altered significantly, please specify proposed alterations:
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Page 3
Occupancy Permit Application For
Occupancy of Property Following
Withdrawal Pursuant to the Ellis Act
Rev. 7/09
PART 4 INTENDED OCCUPANCY CHARACTERISTICS
To be filled in if this application is for residential occupancy
Applicants who wish to use the property for residential purposes must complete the following:
1. a.) Will a unit be occupied by the owner? _____Yes _____No
b.) Which unit will be so occupied _____ unit #
c.) Owner’s name ____________________________________________
d.) Will any of the other units be occupied? _____Yes _____No
e.) List the name(s) of the person(s) other than owner who will be occupying the units and which
units will be so occupied:
Name
Unit No.
No more than one unit may be occupied by an owner of the property. The owner can have other
persons living in the other units, provided those persons do not have any ownership interest in the
property and do not pay rent.
2. Will the property be returned to use as multi-family rental housing?____________
If yes, then the Rent Control Certification below must be completed.
3. Will the property be used as a Cooperative Apartment?____________
If Cooperative is proposed for the property, Subdivision Map and Conditional Use Permit are also
required in addition to this application (see below).
FOR MULT-FAMILY RENTAL HOUSING – RETURN WITHDRAWN UNITS TO RENTAL MARKET
RENT CONTROL BOARD CERTIFICATION (to be completed by Board Staff Member)
The applicant has complied with requirements set forth in the Government Code Sections 7060.2
and 7060.4 and with applicable regulation promulgated by the Rent Control Board.
Name
Date
Title
FOR COOPERATIVE APARTMENTS ONLY:
Has a subdivision map been obtained in accordance with Chapter 3 of Article IX of the Santa Monica
Municipal Code? _____Yes _____No
Please provide the Tentative Tract Map (TTM) or Parcel Map number and the date of its approval:
Date of Approval ________ TTM No. or Parcel Map No. ________
Date of approval for the Final Tract Map:________
Page 4
Occupancy Permit Application For
Occupancy of Property Following
Withdrawal Pursuant to the Ellis Act
Rev. 7/09
PART 5 CERTIFICATION
OWNER:
I CERTIFY UNDER PENALTY OF PERJURY that the information contained in this application is
correct.
Owner’s Signature
Date
Driver’s License Number and State of Issuance
Expiration Date
OCCUPANT/S
With this signature, I declare I will not transfer money, provide services, or offer other forms of
compensation to the owner in exchange for residency within the subject property.
Occupant’s Signature
Date
Occupant’s Signature
Date
Occupant’s Signature
Date
Occupant’s Signature
Date
Occupant’s Signature
Date
F:\CityPlanning\Share\Templates\Applications\Occupancy Permit Application - Ellis Act.doc
Last Modified July, 2009
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CITY OF SANTA MONICA CITY PLANNING DIVISION Building

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Completed 9 December 2020

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