Mechanics Lien Form - California
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3Recording Requested By:
Name:
Address:
When Recorded Mail To:
Name:
Address:
SPACE ABOVE THIS LINE FOR RECORDERS USE
MECHANIC’S LIEN
THE UNDERSIGNED CLAIMANT, _____________________________________ (Name as printed on
contractor’s license), CLAIMS A LIEN FOR LABOR, SERVICES, EQUIPMENT AND/OR MATERIALS UNDER CALIFORNIA
CIVIL CODE SECTION 2082 ET SEQ., UPON THE PREMISES HEREINAFTER DESCRIBED, AND UPON EVERY ESTATE OR
INTEREST IN SUCH STRUCTURES, IMPROVEMENTS AND PREMISES HELD BY ANY PARTY HOLDING ANY ESTATE
HEREIN. THE LABOR, SERVICES, EQUIPMENT AND/OR MATERIALS WERE FURNISHED FOR THE CONSTRUCTION OF
THOSE CERTAIN BUILDINGS, IMPROVEMENTS OR STRUCTURES NOW UPON THAT CERTAIN PARCEL OF LAND
SITUATED IN THE COUNTY OF __________________________, STATE OF CALIFORNIA, SAID LAND DESCRIBED AS
FOLLOWS:
Address: ________________________________________________________________
and/or legal description : __________________________________________________
THE LIEN IS CLAIMED FOR THE FOLLOWING LABOR, SERVICES, EQUIPMENT OR MATERIALS:
Description: _____________________________________________________________
_____________________________________________________________
THE SUM OF $_________________, TOGETHER WITH INTEREST THEREON AT THE RATE OF ____ PERCENT PER
ANNUM FROM _____________________________ (Date when sum became due), IS DUE CLAIMANT, AFTER
DEDUCTING ALL JUST CREDITS AND CLAIMANT FURNISHED THE LABOR, SERVICES, EQUIPMENT AND/OR
MATERIALS AT THE REQUEST OF, OR UNDER CONTRACT WITH:
Name: _________________________________________________________________
Address: _______________________________________________________________
THE OWNER(S) OR REPUTED OWNER(S) OF SAID PREMISES IS/ARE:
Name: _________________________________________________________________
Address: _______________________________________________________________
DATE: _________________
NAME OF CLAIMANT: ______________________________
(Claimant Name)
By:
_____________________________
(Signature of Claimant or Authorized Agent)
VERIFICATION
I, _________________________________, declare that I am the _________________________ (“Owner of”,
“President of”, “Authorized Agent of”, “Partner of”, etc.) the claimant named in the foregoing Mechanics Lien. I
have read said Mechanic’s Lien and know the contents thereof; the same is true of my own knowledge.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on _____________________, 20__, at ________________________ (city), California.
___________________________________
(Signature of Claimant or Authorized Agent)
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