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<br />14 <br /> <br />JUNIOR ACCESSORY DWELLING UNIT (JADU) INCLUSIONARY UNIT <br /> ANNUAL SURVEY <br /> <br />Please submit your completed survey electronically within 30 days to: <br />City of Pleasanton Housing Division – housing@cityofpleasantonca.gov <br /> <br />Owner Name(s): <br /> <br />Unit Address & Development: <br /> <br />Mailing Address: <br /> <br />Contact Information (email & phone number): <br /> <br />Rental and Ownership Verification <br />Your secondary unit is a JADU Inclusionary Unit restricted for income-eligible households. <br /> <br />To verify the maximum monthly rent a tenant may be charged and household income limits, visit: <br />https://www.cityofpleasantonca.gov/our-government/housing/housing-programs/#rental-housing <br /> <br /> YES NO <br />1. I am currently renting my JADU Inclusionary Unit to another household/individual. □ □ <br /> <br />If yes: <br /> <br />a. Indicate the monthly rent being charged. $_______ <br /> <br />b. Identify the number of persons in the tenant household. ________ <br /> <br />c. Indicate the annual gross income of the tenant household $_______ <br /> <br />d. Provide a copy of the lease agreement to the City. <br /> <br />2. Provide a copy of your current homeowner’s insurance to the City. <br /> <br />I understand that there are restrictions on my property and if I choose to refinance, sell, or rent my <br />property, I must contact the City of Pleasanton Housing Division at 925-931-5011 or at <br />housing@cityofpleasantonca.gov. <br /> <br />I understand that, per my Secondary Unit Regulatory Agreement, if I choose to rent my JADU Inclusionary <br />Unit, the monthly rent cannot exceed one-twelfth of thirty percent (30%) of the 80% Area Median Income <br />(AMI), adjusted for household size, less a utility allowance as specified by the Housing Authority of the <br />County of Alameda (HACA.net). <br /> <br />In affixing my/our signature/s below, I/we affirm that all information provided in this form is true and <br />correct. I/we understand that if any information is falsely reported, the City of Pleasanton may take <br />legal action against me/us. <br /> <br />___________________________________________________________ _____________________________________ <br />Signature of Owner, Print Name Date <br /> <br />___________________________________________________________ _____________________________________ <br />Signature of Owner, Print Name Date <br />Page 211 of 344