California Agreement Room Form – Fill Out and Use This PDF

UCSB COMMUNITY HOUSING OFFICE

University Center, Santa Barbara, CA 93106-7160

E-Mail: ucsbcho@housing.ucsb.edu v www.housing.ucsb.edu

Phone: 805-893-4371

ON-LINE LISTINGS v EDUCATION v DISPUTE RESOLUTION v RENTAL SUCCESS GUIDE

RENTAL AGREEMENT FOR A ROOM IN A PRIVATE HOME

This Agreement is between_____________________________________________________(Property Provider) and

___________________________________________________________________________________(Tenant)

for the rental of a room located at _____________________________________________________________.

The monthly rent is $_____________, payable on the _______________ day of every month.

A security deposit of $______________, including Last Month’s Rent ( Yes No ), paid on __________________

(date), shall be refunded by Property Provider within 21 days following Tenant’s move-out, less any appropriate and reasonable charges for cleaning and/or for damages caused by Tenant and/or Tenant’s guests.

With 30 days written notice to Tenant, Property Provider may raise the rent, alter the terms of the agreement, or terminate the tenancy; 60 days written notice will be given to terminate the tenancy if Tenant has resided on the premises for at least one (1) year. Conversely, the Tenant MUST give Property Provider 30 days written notice of intent to quit the premises.

Property Provider agrees to provide the following:

r Electricity	r Gas	rDSL/Internet Service
r Trash Removal	r Water	r Other _______________________
r Cable TV	r Gardener	r Other _______________________

Property Provider and Tenant agree to honor the following House Rules and any additional written Rules attached:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Room Maintenance and Privacy: Tenant shall maintain room in a safe, clean and sanitary condition. Other than in emergency situations, Property Provider may enter room to initiate repairs only after giving Tenant 24-hour advance written notice.

In case of emergency, Tenant authorizes Property Provider to contact:

Name/Relationship:_________________________________________ Phone:___________________________

Name/Relationship:_________________________________________ Phone:___________________________

Sample Form

UCSB Community Housing Oice / www.housing.ucsb.edu 43

RENTAL AGREEMENT FOR ROOM IN A PRIVATE HOME, PAGE 2

By initialing as provided, Tenant acknowledges the receipt of the following documents (copies of which are attached hereto) and are incorporated herein by reference:

______ House Rules	______ Megan’s Law
______ Inventory & Condition Report	______ Furniture Inventory & Condition Report
______ Repair / Replacement Agreement	______ Lead Paint Disclosure
______ Maintenance Request Form	______ Inventory of Personal Property
______ Other: _____________________	______ Other: ______________________

The undersigned have read the foregoing Lease prior to execution & acknowledge receipt of a copy.

Dated this ____ day of ________________, of the year __________
Tenant(s) Signature(s):
_________________________________________________________________	___________________
1st Tenant	Date
_________________________________________________________________	___________________
2nd Tenant	Date
_________________________________________________________________	___________________
3rd Tenant	Date
Property Provider’s Signature:
_________________________________________________________________	___________________
Full Name	Date

Sample Form

44 UCSB Community Housing Oice / www.housing.ucsb.edu