Resolution Number CRA 11-06-07-01RESOLUTION NO. CRA 11-06-07-01
A RESOLUTION OF THE BOARD OF DIRECTORS OF THE SAN JUAN
CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY APPROVING
THE REVISIONS TO THE SAN JUAN CAPISTRANO COMMUNITY
REDEVELOPMENT AGENCY LITTLE HOLLYWOOD AFFORDABLE
RENTAL HOUSING PROGRAM GUIDELINES & OPERATING
PROCEDURES
WHEREAS, the San Juan Capistrano Community Redevelopment Agency (the
"Agency") owns the Little Hollywood project located on Assessor's Parcel Nos. 649-281-
05, 121-142-01 and 121-142-07 on Mission, Ramos Way, and Ramos Streets within the
Los Rios District; and,
WHEREAS, the Agency rents the housing units to low and very -low income households;
and,
WHEREAS, the Agency adopted the San Juan Capistrano Community Redevelopment
Agency Little Hollywood Affordable Rental Housing Program Guidelines & Operating
Procedures on April 18, 2000; and,
WHEREAS, on August 16, 2005, the Agency adopted Declaration of Conditions,
Covenants and Restrictions to make the units available for rent to low and very -low
income households for a period of not less than 55 years to fulfill the Agency's
inclusionary housing obligation; and,
WHEREAS, the Agency Updates the San Juan Capistrano Community Redevelopment
Agency Little Hollywood Affordable Rental Housing Program Guidelines & Operating
Procedures on August 16, 2005; and,
WHEREAS, on December 15, 2009, the Agency completed ten additional units to be
included within the Little Hollywood Affordable Rental Housing Program; and,
WHEREAS, the Agency Little Hollywood Affordable Rental Housing Program Guidelines
& Operating Procedures require revisions to be consistent with the affordability
covenants, state regulation, and management practices.
NOW, THEREFORE, BE IT RESOLVED, that the Board of Directors of the San Juan
Capistrano Community Redevelopment Agency, San Juan Capistrano, does hereby
approve the revisions to the Little Hollywood Affordable Rental Housing Program
Guidelines & Operating Procedures attached hereto as Exhibit A.
-1P7/I7
PASSED, APPROVED, AND ADOPTED this 7th day of June, 2011.
LAURA FREESE, CHAIRMAN
ATTEST:
MARIA MORRIS( -1 ENY SECRETARY
STATE OF CALIFORNIA )
COUNTY OF ORANGE
CITY OF SAN JUAN CAPISTRANO )
I, MARIA MORRIS, appointed Agency Secretary of the Community Redevelopment Agency
of the City of San Juan Capistrano, do hereby certify that the foregoing Resolution No.
CRA 11-06-07-01 was duly adopted by the Board of Directors of the Community
Redevelopment Agency at a regular meeting thereof, held the 7th day of June, 2011 by the
following vote:
AYES:
NOES
ABSENT:
ABSTAIN
DIRECTORS:
DIRECTORS:
DIRECTORS -
DIRECTORS:
Allevato,
Reeve
None
Taylor
Kramer and Chair Freese
Z
6/7/11
EXHIBIT "A"
SAN JUAN CAPISTRANO. COMMUNITY REDEVELOPMENT AGENCY
LITTLE HOLLYWOOD AFFORDABLE RENTAL HOUSING PROGRAM
GUIDELINES & OPERATING PROCEDURES
Adopted April 18, 2000
Amended August 16, 2005
Amended June 07, 2011
I. INTRODUCTION
The San Juan Capistrano Community Redevelopment Agency (Agency) acquired,
rehabilitated, and constructed single-family residences in the area known as Little
Hollywood. The purpose of the program is to provide affordable housing to lower and
very -low income tenant households for a period of three -to -five years to allow sufficient
time for the households to improve their financial situation and become self-sufficient.
The program guidelines and operating procedures provide a basis for determining
applicant eligibility and rules that are to be followed by all tenant's households.
II. DEFINITIONS
Tenant Household - One household per unit occupied by those persons identified on
the executed residential lease.
Extremely Very -Low Income. Household -A household with a combined annual income
for all household members 18 years of age or older that does not exceed 30 percent of
the Orange County annual median income.
Very -Low Income Household - A household with a combined annual income for all
household members 18 years of age or older that does not exceed 50 percent of the
Orange County annual median income.
Lower-income Household - A household with a combined annual income for all
household members 18 years of age or older that does not exceed 80 percent of the
Orange County annual median income.
Rental Subsidy Waiting List - A list maintained by the City of San Juan Capistrano's
Planning Services Department of those persons that have submitted a written request
to be added to a waiting list to receive rental assistance from the City/Agency.
Declaration of Conditions Covenants and Restrictions - A document adopted by the
Community Redevelopment Agency on August 16, 2005, that restricts the maximum
incomes for households and the maximum rents the Agency may charge for the
Agency's housing units within the Agency's project area boundaries for a period of 55
years.
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Housing Units - The Little Hollywood rental units located on Assessor's Parcel
Nos. 649-281-05, 121-142-01, and 121-142-07 in the Los Rios District within the
Community Redevelopment Agency project boundaries that are owned by the
Community Redevelopment Agency.
Housing Development -- The Little Hollywood property owned by the Community
Redevelopment Agency on Assessor's Parcel Nos. 649-281-05, 121-142-01, and
121-142-07 located in the Los Rios District, adjacent to Mission Street, Ramos
Way, and Ramos Street in the City of San Juan Capistrano.
Monthly Rent - The total of monthly payments for use and occupancy of the
Housing Unit and land and facilities associated therewith in accordance with
Section V (Monthly Rental Amount) of these regulations. Additional monthly fees,
utility charges, or service charges which are required of all tenants may be
assessed by the Agency.
Utility Allowance - The amount that may be added to the monthly rent each month
for all tenant households for utility services provided by the Agency pursuant to the
Utility Allowance published annually by the County of Orange Housing & Community
Services Development Multi -Family Affordable Rental Housing Utility Allowance.
III. ELIGIBLE TENANT HOUSEHOLDS
A. U.S. Citizenship/Permanent Alien Resident Status - All occupants of the
tenant household must be either a U.S. citizen or a permanent resident
alien. A valid social security card, proof of citizenship and/or permanent
residential alien status must be provided for all members of the household.
B. Income Eligibility - For the purpose of this program, the tenant households
must be certified as income eligible as a lower and/or very -low income
household. The definition of a lower-income household is a Tenant
Household that has a gross annual income that does not exceed 80 percent
of the Orange County median income, adjusted for household size. A very -
low income household is a tenant household that has a gross annual
income that does not exceed 50 percent of the Orange County median
income adjusted for household size. Income levels will be established
annually on October 1St, based on information provided by the U.S.
Department of Housing and Community Development as amended
annually, for the SJC-CRA.
In accordance with the Declaration of Conditions, Covenants and Restrictions
adopted by the Agency on August 16, 2005, four (4) of the housing units shall
be made available, rented and occupancy restricted to Lower Income
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households at an affordable rent, and an additional twenty (20) housing units
shall be made available, rented and occupancy restricted to Very Low
Income households at an affordable rent. Units occupied prior to August 16,
2005, with gross annual household income exceeding the lower-income
household maximum, shall be eligible to remain in the Dousing units
provided their income does not exceed 80 percent of the median income,
adjusted for household size. The designation of particular housing units as
lower income units or very low income units shall be in the sole discretion of
the Agency. The unit sizes shall be rented to lower and very -low income
households as follows:
No. of Bedroom Very -Low Income Lower Income
4 _ __._.._._..__._..._... .....
.._.._......
C. Determination of Income - Gross annual income, includes all payments from
all sources that are anticipated to be received by all adult members of the
Tenant Household over the subsequent twelve (12) month period of tenancy
(Exhibit C of the Declaration of Conditions, Covenants and Restrictions).
D. Household Priority - The program will assist income -eligible households on
the affordable housing rental subsidy waiting list according to the following
preferences.
• A household that is willing to take action to improve their circumstances and
works towards becoming self-sufficient within three -to -five years.
• Current Little Hollywood Tenant in overcrowded unit w/minor children
• Current Little Hollywood Tenant in overcrowded unit w/no minor children
• Currently living or working in the City of San Juan Capistrano
• A household that resides in an uninhabitable dwelling unit (as determined by
the City's Building Official pursuant to the provisions of the Uniform Building
Code), transitional dwelling unit, or an overcrowded dwelling unit (as
determined by Section IV (Household Size) of these regulations).
E. Alcoholic and/or Drug Abuse - No person or persons who is/are abusing
alcohol and/or using illegal drugs shall be eligible to participate in the
program. To determine if a household is abusing alcohol and/or using illegal
drugs, the Agency will conduct a background check and interview each
household during the screening process.
F. A tenant household can be rejected for a criminal history that includes any
illegal activity in violation of Federal, State, or local laws, including but not
limited to: of physical/sexual abuse, sale or distribution of controlled
substances, and any acts of violence that could affect the health, safety or
welfare of other residents.
Page 3 out of 12
IV. APPLICATION PROCESS
A. Initial application - Upon availability of a unit, staff will contact the
households on the waiting list in accordance with the criteria set forth in
Section II (D)(Household Priority) above. Staff will attempt to contact the
party by mail and by phone. If staff is unable to contact the interested party
after thirty (30) days, the name will be deleted from the waiting list When an
interested party is contacted, they will have thirty (30) days from receipt of the
tenant application package to complete all documents and submit all
necessary information to the Agency. Failure to do so will result in
determining the applicant ineligible for the program.
Upon verification of all eligibility requirements, the tenant will be required to
sign the standard lease document and move -in within forty-five (45) days.
Failure to do so will result in determining the applicant ineligible for the
program.
B. Background Checks - A criminal record check will be required for each adult
household member prior to execution of a residential lease or at any other
time as deemed necessary at the Agency's discretion. An application for
tenant household can be rejected for a criminal history that includes
physicallsexual abuse, sale or distribution of controlled substances, and any
acts of violence that could affect the health, safety or welfare of other
residents.
C. Annual Re -certification - Each year on October 1st, each existing tenant
household will be required to complete the tenant application package and
submit it to the Agency no later than the following November 1st. Agency
staff will review the application and make a determination on eligibility for the
coming calendar year. Tenant households meeting the eligibility
requirements and interested. in continuing in the program will be required to
execute their new lease no later than December 31St. Failure to submit re-
certification information by November 1st or execute a new lease document by
December 31st, will result in determining the tenant household ineligible for the
program.
If the Agency determines that a tenant household's income exceeds the
lower-income eligibility requirements, the household will be deemed ineligible
to continue in the program. Upon determination by the Agency during this
recertification process that the household does not meet the income
requirement, any subsequent decrease in household income in order to meet
the income requirement will not change the Agency's decision to require the
tenant to vacate the unit. The Agency may consider, at its discretion, any
adjustments to the lease and/or rent payments during the year due to
unforeseen circumstances.
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V.
M
Tenant households residing in the housing unit prior to adoption of these
revised guidelines on August 16, 2005, shall be allowed to exceed the
lower-income eligibility requirements provided their household income does
not exceed the low-income eligibility requirements. The Agency shall
provide 90 days notice to the tenant household in writing that the tenant
household has been deemed ineligible and shall be required to move out of
the unit. The Agency may, at its sole discretion, extend the tenant's move -
out deadline by an additional 60Aays due to justifying circumstances. The
Agency will review a tenant household's income once annually. if a tenant
household's income decreases for whatever reason after the date of the
Agency's determination of ineligibility, the original income certification will
apply and the tenant household will be required to vacate the unit.
HOUSEHOLD STATUS & SIZE
All members of the household must be U.S. citizens or permanent resident
aliens. Proof of citizenship or resident alien status will be required of all
household members.
The household size must comply with that approved in the residential lease. The
premises shall only be used as a residence by the lessees. Occupancy shall be
limited to those persons indicated in the residential lease, and no additional
occupants may reside at the premises without prior written consent of the Agency.
Any persons who desire to live in the unit, including new family members by
marriage, must apply through the resident selection process. If a household size
decreases to below the minimum number of people allowed, the occupant shall
be required to transfer to the next available unit for which they qualify based upon
their household size or move out of the unit. If no unit is available in the Little
Hollywood Housing Development, the Agency may require the household to move
to another affordable unit elsewhere in the City or to move out of the unit. If, during
the year, the household size increases to above the maximum number of people,
the tenant household will not be eligible to be certified in the following year.
The occupancy limits are outlined as follows:
Unit Size Minimum Maximum
# Of Bedrooms Number Of Persons Number Of Persons
0 1 2
1 1 3
2 2 5
3 5 7
MONTHLY RENTAL AMOUNT
The Monthly Rent payable by a Lower -Income Household shall not exceed -one-
twelfth (1/12) of thirty percent (30%) of eighty percent (80%) of Orange County
Page 5 out of 12
median income, as determined by regulation of the State of California, for a
household size appropriate to the unit or the current market rent based upon unit
size in accordance with the Orange County Income and Rents limit issued annually
by the County of Orange, whichever is lower.
The Monthly Rent payable by a Very -Low Income Household shall not exceed one -
twelfth (1112) of thirty percent (30%) of fifty percent (50%) of Orange County
median income, as determined by regulation of the State of California, for a
household size appropriate to the unit or the current market rent based upon unit
size in accordance with the Orange County Income and Rents limit issued annually
by the County of Orange, whichever is lower.
The Monthly Rent payable by a Extremely Very -Low Income Household shall not
exceed one -twelfth (1112) of thirty percent (30%) of thirty percent (30%) of Orange
County median income, as determined by regulation of the State of California, for a
household size appropriate to the unit or the current market rent based upon unit
size in accordance with the Orange County Income and Rents limit issued annually
by the County of Orange, whichever is lower.
The maximum Monthly Rent chargeable for the Housing Units shall be annually
determined by the Agency in accordance with the foregoing requirements. If, based
upon an updated income certification, a tenant no longer qualifies as a Very- Low
Income Household, the Agency shall rent the next available Housing Unit and any
necessary Housing Units thereafter to a Very -Low Income Household in accordance
with the terms of the affordability covenant agreement. In addition, except in the
event of fraud or misrepresentation, no tenant shall be denied continued occupancy
in a Housing Unit solely because such tenant no longer qualifies as a Very -Low
Income Household because of an increase in household income subsequent to
such tenant's initial date of occupancy, provided that the tenant qualifies as a
Lower -Income Household as, provided for below.
Notwithstanding the foregoing, if a tenant's income exceeds the qualifying limits for a
Very -Low Income recertification but qualifies as a Lower-income Household, the
Agency may increase the monthly rent payable by such tenant in accordance with
the monthly rental amount for a Lower-income Household. Upon the vacation of
the Housing Unit by such tenant, the Housing Unit shall be rented to an Extremely
Very -Low, Very -Low, or Lower -Income Household, in accordance with the
requirements of the DECLARATION OF CONDITIONS, COVENANTS AND
RESTRICTIONS adopted by the San Juan Capistrano Community Redevelopment
Agency on August 16, 2005.
VII. CRITERIA FOR CONTINUED RESIDENCY
The San Juan Capistrano Community Redevelopment Agency, at its sole
discretion, may require the tenant household to vacate the affordable housing units
for any of the following reasons:
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A. The tenant household is no longer income eligible (i.e. income exceeds
80% of area median income adjusted for household size).
B. The tenant household fails to complete the recertification process.
C. The tenant household has resided in the housing development for three
years and has made no progress towards increasing their income and/or
education. Participating eligible households that have complied with the
guidelines and operating procedures and performance standards set forth in
these guidelines may reside in the housing development for up to three
years, with the possibility of renewal for two additional one-year leases. To
qualify for renewal of up to two additional one year leases, the tenant
household must provide written documentation to the Agency staff each year
that they have made progress towards improving their financial situation
and/or education.
D. A tenant household has resided in the housing development for the
maximum of five years.
E. If it is determined by the Agency that any member of the tenant household
is;
i. Using the housing unit or any portion of the housing development for the
illegal sale or use of drugs and other controlled substances as defined
by Penal Code and the Health and Safety Codes of the State of
California.
ii. Arrested during the term of the lease for use, sale, distribution or
delivery of illegal drugs.
iii. Conducting any illegal activity in violation of Federal, State, or local laws
including but not limited to: of physical/sexual abuse, sale or distribution
of controlled substances, and any acts of violence that could affect the
health, safety or welfare of other residents.
F The tenant household fails to comply with the program guidelines and
operating procedures.
F. The tenant household fails to pay the monthly rent on time per the terms of
the residential lease.
VIII. CRITERIA FOR TRANSFER TO ANOTHER UNIT
The San Juan Capistrano Community Redevelopment Agency, at its sole
discretion, may require the tenant household to transfer into another affordable
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housing unit within the Little Hollywood Housing Development or transfer to an
affordable unit located elsewhere in the City, for any of the following reasons:
A. If the Agency determines that a tenant household is no longer able to
provide day-to-day maintenance of the unit and/or to maintain the unit in a
clean, safe, sanitary and attractive condition, including landscaping.
B, If the tenant household size has decreased below the minimum number of
persons, the occupant shall be required to transfer to the next available unit
for which they qualify based upon their household size. If no unit is available
in the Little Hollywood Housing Development, the Agency may require the
household to move to another affordable unit elsewhere in the City or to
move out of the unit.
IX. TENANT RULES AND REGULATIONS
A. SUBLETTING OF HOUSING UNIT - Subletting of any Housing Unit by the
tenant household is prohibited and may result in eviction by the Agency of the
tenant household.
B. MAINTENANCE - Tenants are required to provide minor day-to-day
maintenance of their units. This includes but' is not limited to minor
landscape maintenance, trash pickup, etc. Personal household items such as
furniture, appliances, etc. shall not be kept outside the dwelling and/or within
vision of other tenants so as to become an eyesore. These items are to be
kept in storage. Under no circumstances will tenant store or allow to be stored
any items within the common areas of the neighborhood.
C. MAINTENANCE OF COMMON AREAS - The Agency shall maintain all
common area landscaping.
D. STORAGE SHEDS & CARPORT STORAGE- Storage sheds & carport
storage will be used for storage of yard and personal items. Tenants will not
allow storage sheds to be used as living quarters. Tenants will observe
proper storage requirements for combustibles.
E. TRASH - Trash shall be disposed of in the containers provided by CR&R.
Tenants shall follow the guidelines provided by the Agency for disposal of
trash. Large items may be picked up by CR&R with prior approval.
Residents shall be provided with three bins, black for general trash (non -
recyclable), blue for recyclables and green for green (plant) waste.
F. AGENCY INSPECTION - Each tenant household shall be required to allow
access of their rental unit for monthly site inspections, or as deemed
necessary by the Agency or its designated consultant, to verify household
size, maintenance of the unit, and adherence to the program rules.
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G. PARKING - Each household will have available parking for two vehicles that
must be in operating condition and have current registration and insurance.
Guests will park in the designated guest parking spaces. No parking of any
vehicle is allowed on the street or common areas. Guest parking spaces shall
not be used for vehicle repair. Driveways and parking areas shall be kept
free from debris and items that may be hazardous to vehicular and
pedestrian traffic. Each tenant will be issued two parking permits for their
permanent vehicles and one guest permit. Vehicles not displaying parking
permits on Agency property will be subject to tow, at the vehicle owner's
expense. In the event a tenant wishes to have a larger gathering and use
more than one guest space, the tenant must request approval for the event
seven days before the event and receive temporary guest parking permits
from the Agency or their agent in writing seven days before the event. Event
guest parking permits must be visible on the dashboard on the day of the
event.
H. NUISANCES - No noxious or offensive activity (including but not limited to
the repair of motor vehicles) shall be carried on, in or at any housing unit or
within the housing development common areas. A tenant household shall not
do anything which may be or become an unreasonable annoyance or a
nuisance to any other tenants in the housing development. Without limiting
the generality of the foregoing provisions, no loud noises or noxious odors, no
exterior speakers, horns, whistles, bells or other sound devices, noisy or
smoky vehicles, large power equipment or large power tools, unlicensed off-
road motor vehicles or items which may be unreasonably interfere with
television or radio reception of any tenant household in the housing
development, shall be located, used, or placed on any portion of the housing
development or exposed to the view of other tenant households without the
prior written approval of the Agency. The Agency shall have the right to
determine if any noise, odor, interference or activity producing such noise,
odor or interference constitutes a nuisance.
I. COURTESY TO OTHER RESIDENTS - Residents shall respect the peace
and privacy of others. Tenants shall not make nor permit any disturbing
noises. Any disturbances should be reported to Agency staff.
J. GUESTS -- Occupants must receive prior written approval from the Agency
for guests staying over seven consecutive days within any 60 -day period.
Occupancy by guests, including family members, staying over seven
consecutive days or for seven days within any 60 -day period, without prior
approval of the Agency, will subject the tenant household to eviction.
Situations where tenants wish for guests to stay over the allowed seven
days will be reviewed on a case by case basis, and will require Agency
approval a minimum of 14 days prior to a guest arriving.
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K. PROGRAM PARTICIPATION - All tenant households shall be required
to
participate in appropriate classes, workshops, and other activities as
assigned, at the discretion of the Agency.
L. PERFORMANCE STANDARDS - All tenant households shall be evaluated
monthly based upon the following performance standards:
i. Household size and occupancy must comply with that listed in the lease
agreement.
ii. Tenant household must maintain the housing unit in a satisfactory and
safe living environment.
iii. Tenant household must maintain the exterior and the interior of the
housing unit in a clean, sanitary, and attractive condition (including
landscaping)
iv. Tenant household must pay the rent on time per the terms in the lease
agreement.
V. Tenant household members must comply with the Little Hollywood
Affordable Rental Housing Program Guidelines and Operating
Procedures.
Unless exempted, all tenant households must comply with the following
additional performance standards:
i. All adult members of the household shall be employed or be a full-time
student, unless retired or physically unable to work.
ii. Tenant households shall be required to participate in a tenant education
program that will be provided by either the Agency or a designated
agency or Consultant that includes the following:
a. Work with a case manager in preparing a monthly family budget (to
include all monthly income and expenses) with the goal of saving
10 — 30 percent of their net income each month in a verifiable
savings account;
b. Attend group sessions at a designated location in San Juan
Capistrano;
c. Attend individual counseling, if recommended (parent/marital, anger
management, children and teens evaluations and tutorial
assistance);
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d. Attend monthly meetings with an assigned case manager to assess
and evaluate the household's goals;
e. Complete required monthly paperwork (as assigned),
f. Work with case manager to prepare a goals sheet.for each adult in
the household (as assigned);
g. Submit supporting documents for monthly budget report (i.e. proof of
income, pay stubs, child support documents, notice of action forms,
bills received/paid, merchandise and grocery receipts, etc.)
h. Agree to allow a monthly in-home visit by assigned case manager or
the Agency;
Attend workshops and classes, as assigned.
iii. Tenant households shall be required to perform 5-6 hours of community
service volunteer work monthly. Volunteer work shall be coordinated by
the Agency or the Agency's property management company.
At the Agency's discretion, a tenant household's failure to meet the performance
standards may be grounds for termination of the lease.
M. PETS- Pets are not allowed on the premises. Exceptions can be made for
small animals, under five pounds, and service animals; however, the Agency
or its representative must receive a written request for an exception. A written
approval or refusal will be returned to the tenant within fourteen (14) days of
reception of the exception request. A pet agreement and fee may be required
for the allowance of a pet.
X. GRANDFATHER CLAUSE
Tenant households with at least one member of the household 62 years of age or
older as of August 15, 2005 shall be exempted from the three -to -five year term of
residency requirement provided the tenants comply with all other provisions
contained in these guidelines.
XI. RIGHT TO AN INFORMAL HEARING PROCEDURE
Program participants may appeal a proposed program action that may have an
adverse effect upon them by submitting a written request for a hearing to the City
of San Juan Capistrano Planning Department. The written request shall include
the participating tenant household's objection, the name and relationship of all
potential parties, a list of documents to' be presented, and the tenant household's
current address and telephone number.
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The San Juan Capistrano Community Redevelopment Agency shall appoint a
hearing officer. Once a hearing officer is appointed, an informal hearing will be
scheduled as soon as possible. The informal hearing shall be conducted in
English. Notice of Informal Hearing will be issued at least ten days prior to the
hearing date. The participating tenant household may bring legal counsel and/or a
translator at participant's expense. The participating tenant household may bring
person(s) to testify and/or documents at the participant's expense. The
participating tenant households may review pertinent file documentation as long as
such documentation does not infringe on any other party's rights.
Within ten business days following the informal hearing, the hearing officer's official
decision will be mailed to the tenant household. The hearing officer's decision shall
be final
XII. EXCEPTIONS
No exceptions to these guidelines will be authorized without Community
Redevelopment Agency approval.
XIII. ACKNOWLEDGMENT AND AGREEMENT
By signing below I acknowledge understanding of all the above program
guidelines and agree to participate within the Little Hollywood Rental Assistance
Program according to the above guidelines.
Household Name -Printed Date
Signature Signature
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