Notice of Acceptance

NOTICE OF ACCEPTANCE OR REJECTION OF DISPUTED WORK

(Individual as Direct Contractor)

Name of direct contractor:

Street Address:

City, State and Zip Code:

Name of owner:

Street Address:

City, State and Zip Code:

Name of construction lender:

Street Address:

City, State and Zip Code:

Site of the Improvement:

Street Address:

City, State and Zip Code:

Legal Description:

COMES NOW, the direct contractor for the work of improvement at the above site location and provides notice that the undersigned will accept reject the disputed work that has been submitted as completed.

Dated:

Notice of Acceptance or Rejection of Disputed Work

CA Civil Code § 8816 Page 1 of 2

PROOF OF NOTICE DECLARATION

(Civil Code § 8118)

I, declare that I have served copies of the NOTICE OF ACCEPTANCE OR REJECTION OF DISPUTED WORK by (check appropriate box below):

a. By personally delivering copies to:

Name:

Title:

At: (Street Address)

City, State and Zip Code:

On: 20 at am / pm.

[Provide the above information for all other parties personally served on attached Exhibit A]

b. By Certified, Express, or Registered Mail Service, postage prepaid addressed to:

Name:

Title:

At: Street Address:

City, State and Zip Code:

On: 20 at

[Provide the above information for all other parties served by mail / express service on attached Exhibit A]

See attached documentation provided by the US Postal Service or express mail service showing the date of delivery and the name of the person accepting delivery; tracking record or other documentation from express carrier showing attempted delivery or delivery of the notice; or, in the event of non-delivery, the returned envelope itself.

I declare under penalty of perjury that the foregoing is true and correct.

Signed at , California on 20

SWORN TO AND SUBSCRIBED before me on this the day of

20

Notice of Acceptance or Rejection of Disputed Work

CA Civil Code § 8816 Page 2 of 2