Recorded at the request of:
When Recorded Mail to Claimant at:
Space above for recorder’s use only
DESIGN PROFESSIONAL’S LIEN
NOTICE OF LIEN
(California Civil Code §§3081.1 – 3081.10)
1. By this notice, a lien is created in favor of the following design professional:
Name of Claimant:
2. The amount of the Claimant’s lien claim is the sum of $_______________________.
3. The current owner of record of the real property to be improved is:
Name of Owner:
4. The legal description of the real property to be improved and to which the lien attaches is:
5. The building permit or other governmental approval for the work of improvement designed to
be constructed on the above property is
6. Not less than TEN (10) days before the recording of this Notice of Lien, the undersigned design
professional mailed by registered or certified mail, postage prepaid, to the landowner, a written
demand for payment specifying that a default occurred pursuant to the terms of a written
contract for design professional services and the amount of the default.
Signature of Claimant or Authorized Agent
I, the undersigned, say:
I am the ____________________________________ [describe, e.g. claimant, agent of the claimant.] of the design
professional’s lien; I have read said claim of design professional's lien and know the contents thereof; the
same is true of my own knowledge.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on the _____ day of ______________, _______ at _______________________, California.
STATE OF CALIFORNIA )
COUNTY OF ____________ )
On _____________________________, 20_____ before me, ___________________________________ [insert
name and title of the officer], personally appeared ______________________________, who proved to me on
the basis of 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 of Notary Public
PROOF OF SERVICE AFFIDAVIT
I, __________________________________________, declare that I served the above Design Professional’s
Lien – Notice of Lien: (check appropriate box)
(a) (____) By personally delivering a