Fill and Sign the Notice of Non Responsibility Form

Notice of Nonresponsibility Page 1 of 2 CA Civil Code § 8444 Recording requested by: An d, when recorded, return to : Name: City, State, & Zip: Telephone: NOTICE OF NONRESPONSIBILITY (Individual as Owner) Name of owner or reputed owner: Street Address: City, State and Zip Code: Nature of owner’s title or inte rest 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: The name of any purchaser under contract, if applicable: Notice of Nonresponsibility Page 2 of 2 CA Civil Code § 8444 The undersigned is not responsible for any claims or liens arising from the work of improvement as described above. DATE: Signature Print or Type Name I, , declare under penalty of perjury u nder the laws of the State of California, that I have read the above Notice of Nonresponsibility , and I know it is true of my own knowledge, except as to those things stated upon information and belief, and as to those I believe it to be true. Executed , 20 , at , California. Declarant 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, a nd not the truthfulness, accuracy, or validity of that document. State of California , County of On , 20 before me, (here insert name and title of the officer), personally appeared , who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity , and that by his signature on the instrument the person , or the entity upon beh alf of which the person acted, executed the instrument. I certify under PENAL TY 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) Notes: Within 10 days after the person claiming the benefits of nonresponsibility has obtain ed knowledge of the work of improvement, the notice provided for in this section shall be posted in some conspicuous place on the site. Within the same 10 -day period provided for the posting of the notice, the notice shall be recorded in the office of the county recorder of the county in which the site or some part thereof is located.