CODE ENFORCEMENT DIVISION - RESIDENTIAL RENTAL INSPECTION PROGRAM
SELF-CERTIFICATION APPLICATION - AFFIDAVIT
Once approved for self-certification, the owner, agent or designated representative is required to inspect the property on an annual
basis. In addition, you must complete and return the application - affidavit to the City of Hayward Rental Inspection Program. Failure
to return the application - affidavit annually will result in loss of self-certification status.
Owners of rental housing properties in the Self-Certification Program must certify each and every rental housing unit on
the property at least once every calendar year and upon change in tenancy. Self-Certification requires the following:
ect each rental housing unit on the property for compliance with the checklist.
• Immediately make any repairs to the rental housing unit in order to achieve compliance with the requirements of
• Upon completion of the checklist, maintain a copy on file and submit the application – affidavit to the City of
Hayward Residential Rental Inspection Program.
• Immediately notify the City of Hayward Code Enforcement Division if any rental unit cannot be self-certified
because necessary repairs cannot or will not be made.
SIGNER’S ADDRESS: (street number and name)
PLEASE MAIL THE EXECUTED SELF-CERTIFICATION APPLICATION - AFFIDAVIT TO:
y of Hayward
Code Enforcement Division - Residential Rental Inspection Program
777 B Street, 1
Hayward, CA 94541
The signature affixed to this document certifies that the owner or agent has inspected all the units and building exteriors at the
property specified, and that this property is well maintained as detailed in the Self-Certification Checklist. Any falsification of this
document or misrepresentation of the true condition of the property is grounds for dismissal from the self-certification program.
CODE ENFORCEMENT DIVISION – RENTAL INSPECTION PROGRAM
777 B Street, Hayward, CA 94541-5007 - Tel: 510/583-4175 - Fax: 510/583-4994 - http://www.hayward-ca.gov