Fill and Sign the Notice 10 Day Form

NOTICE OF INTENT TO FIULE A 10-DAY STOP WORK NOTICE (Individual as Direct Contractor) Name of owner or reputed owner:       Street Address:       City, State and Zip Code:       Name of direct contractor:       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 above described private work of improvements, at least five (5) days before service upon the owner of a 10-day Stop Work Notice, and hereby provides notice of an intent to file a 10-day Stop Work Notice pursuant to California Code § 8834(a). This Notice has been served upon all subcontractors with whom the undersigned original contractor has a direct contractual relationship on the project at the same time the notice was served upon the owner. Within five days of receipt of this Notice, the owner must forward to the construction lender, if any, at the address provided in the construction loan agreement, a copy of the Notice by first-class mail. Date:       Signature       Type or Print Name Notice of Intent to File 10-Day Stop Work Notice Page 1 of 3 CA Civil Code § 8834 PROOF OF NOTICE DECLARATION (Civil Code § 8118) I,       , declare that I have served copies of the NOTICE OF INTENT TO FILE 10-DAY STOP WORK NOTICE 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       [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 ______ . Signature       Print or Type Name A notary public or other officer completing the certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ______________________ On ______________________ before me, ______________________ (here insert name and title of the officer), personally appeared ______________________ , who proved to me on the basis of Notice of Intent to File 10-Day Stop Work Notice Page 2 of 3 CA Civil Code § 8834 satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. _____________________________________________ Signature (Seal) Notice of Intent to File 10-Day Stop Work Notice Page 3 of 3 CA Civil Code § 8834