(a) A tenant may notify the landlord that the tenant intends to terminate the tenancy if the tenant, a household member, or an immediate family member was the victim of an act that constitutes any of the following:

1. (1) Domestic violence as defined in Section 6211 of the Family Code.
2. (2) Sexual assault as defined in Section 261, 261.5, 286, 287, or 289 of the Penal Code.
3. (3) Stalking as defined in Section 1708.7.
4. (4) Human trafficking as defined in Section 236.1 of the Penal Code.
5. (5) Abuse of an elder or a dependent adult as defined in Section 15610.07 of the Welfare and Institutions Code.
6. (6) A crime that caused bodily injury or death.
7. (7) A crime that included the exhibition, drawing, brandishing, or use of a firearm or other deadly weapon or instrument.
8. (8) A crime that included the use of force against the victim or a threat of force against the victim.

(b) A notice to terminate a tenancy under this section shall be in writing, with one of the following attached to the notice:

1. (1) A copy of a temporary restraining order, emergency protective order, or protective order lawfully issued pursuant to Part 3 (commencing with Section 6240) or Part 4 (commencing with Section 6300) of Division 10 of the Family Code, Section 136.2 of the Penal Code, Section 527.6 of the Code of Civil Procedure, or Section 213.5 or 15657.03 of the Welfare and Institutions Code that protects the tenant, household member, or immediate family member from further domestic violence, sexual assault, stalking, human trafficking, abuse of an elder or a dependent adult, or any act or crime listed in subdivision (a).
2. (2) A copy of a written report by a peace officer employed by a state or local law enforcement agency acting in the peace officer’s official capacity stating that the tenant, household member, or immediate family member has filed a report alleging that the tenant, the household member, or the immediate family member is a victim of an act or crime listed in subdivision (a).

3. (3)

   1. (A) Documentation from a qualified third party based on information received by that third party while acting in the third party’s professional capacity to indicate that the tenant, household member, or immediate family member is seeking assistance for physical or mental injuries or abuse resulting from an act or crime listed in subdivision (a).

   2. (B) The documentation shall contain, in substantially the same form, the following:

      Tenant Statement and Qualified Third Party Statement under Civil Code Section 1946.7
      Part I. Statement By Tenant
      I, [insert name of tenant], state as follows:
      I, or a member of my household or immediate family, have been a victim of:
      [insert one or more of the following: domestic violence, sexual assault, stalking, human trafficking, elder abuse, dependent adult abuse, or a crime that caused bodily injury or death, a crime that included the exhibition, drawing, brandishing, or use of a firearm or other deadly weapon or instrument, or a crime that included the use of force against the victim or a threat of force against the victim.]
      The most recent incident(s) happened on or about:
      [insert date or dates.]
      The incident(s) was/were committed by the following person(s), with these physical description(s), if known and safe to provide:
      [if known and safe to provide, insert name(s) and physical description(s).]
      (signature of tenant) (date)
      Part II. Qualified Third Party Statement
      I, [insert name of qualified third party], state as follows:
      My business address and phone number are:
      [insert business address and phone number.]
      Check and complete one of the following:
      ____I meet the requirements for a sexual assault counselor provided in Section 1035.2 of the Evidence Code and I am either engaged in an office, hospital, institution, or center commonly known as a rape crisis center described in that section or employed by an organization providing the programs specified in Section 13835.2 of the Penal Code.
      ____I meet the requirements for a domestic violence counselor provided in Section 1037.1 of the Evidence Code and I am employed, whether financially compensated or not, by a domestic violence victim service organization, as defined in that section.
      ____I meet the requirements for a human trafficking caseworker provided in Section 1038.2 of the Evidence Code and I am employed, whether financially compensated or not, by an organization that provides programs specified in Section 18294 of the Welfare and Institutions Code or in Section 13835.2 of the Penal Code.
      ____I meet the definition of “victim of violent crime advocate” provided in Section 1947.6 of the Civil Code and I am employed, whether financially compensated or not, by an agency or organization that has a documented record of providing services to victims of violent crime or provides those services under the auspices or supervision of a court or a law enforcement or prosecution agency.
      ____I am licensed by the State of California as a:
      [insert one of the following: physician and surgeon, osteopathic physician and surgeon, registered nurse, psychiatrist, psychologist, licensed clinical social worker, licensed marriage and family therapist, or licensed professional clinical counselor.] and I am licensed by, and my license number is:
      [insert name of state licensing entity and license number.]
      The person who signed the Statement By Tenant above stated to me that the person, or a member of the person’s household or immediate family, is a victim of:
      [insert one or more of the following: domestic violence, sexual assault, stalking, human trafficking, elder abuse, dependent adult abuse, or a crime that caused physical injury, emotional injury and the threat of physical injury, or death.]
      The person further stated to me the incident(s) occurred on or about the date(s) stated above.
      I understand that the person who made the Statement By Tenant may use this document as a basis for terminating a lease with the person’s landlord.
      (signature of qualified third party) (date)

   3. (C) The documentation may be signed by a person who meets the requirements for a sexual assault counselor, domestic violence counselor, a human trafficking caseworker, or a victim of violent crime advocate only if the documentation displays the letterhead of the office, hospital, institution, center, or organization, as appropriate, that engages or employs, whether financially compensated or not, this counselor, caseworker, or advocate.
4. (4) Any other form of documentation that reasonably verifies that the crime or act listed in subdivision (a) occurred.

(c) If the tenant is terminating tenancy pursuant to subdivision (a) because an immediate family member is a victim of an eligible act or crime listed in subdivision (a) and that tenant did not live in the same household as the immediate family member at the time of the act or crime, and no part of the act or crime occurred within the dwelling unit or within 1,000 feet of the dwelling unit of the tenant, the tenant shall attach to the notice and other documentation required by subdivision (b) a written statement stating all of the following:

1. (1) The tenant’s immediate family member was a victim of an act or crime listed in subdivision (a).
2. (2) The tenant intends to relocate as a result of the tenant’s immediate family member being a victim of an act or crime listed in subdivision (a).
3. (3) The tenant is relocating to increase the safety, physical well-being, emotional well-being, psychological well-being, or financial security of the tenant or of the tenant’s immediate family member as a result of the act or crime.

(h) For purposes of this section, the following definitions apply:

1. (1) “Household member” means a member of the tenant’s family who lives in the same residential unit as the tenant.
2. (2) “Health practitioner” means a physician and surgeon, osteopathic physician and surgeon, psychiatrist, psychologist, registered nurse, licensed clinical social worker, licensed marriage and family therapist, licensed professional clinical counselor, or a victim of violent crime advocate.
3. (3) “Immediate family member” means the parent, stepparent, spouse, child, child-in-law, stepchild, or sibling of the tenant, or any person living in the tenant’s household at the time the crime or act listed in subdivision (a) occurred who has a relationship with the tenant that is substantially similar to that of a family member.
4. (4) “Qualified third party” means a health practitioner, domestic violence counselor, as defined in Section 1037.1 of the Evidence Code, a sexual assault counselor, as defined in Section 1035.2 of the Evidence Code, or a human trafficking caseworker, as defined in Section 1038.2 of the Evidence Code.
5. (5) “Victim of violent crime advocate” means a person who is employed, whether financially compensated or not, for the purpose of rendering advice or assistance to victims of violent crimes for an agency or organization that has a documented record of providing services to victims of violent crime or provides those services under the auspices or supervision of a court or a law enforcement or prosecution agency.

(i)

1. (1) A landlord shall not disclose any information provided by a tenant under this section to a third party unless the disclosure satisfies one or more of the following:

   1. (A) The tenant consents in writing to the disclosure.
   2. (B) The disclosure is required by law or order of the court.
2. (2) A landlord’s communication to a qualified third party who provides documentation under paragraph (3) of subdivision (b) to verify the contents of that documentation is not disclosure for purposes of this subdivision.

(k) A landlord or agent of a landlord who violates this section shall be liable to the tenant in a civil action for both of the following:

1. (1) The actual damages sustained by the tenant.

2. (2)

   1. (A) Statutory damages of not less than one hundred dollars ($100) and not more than five thousand dollars ($5,000).
   2. (B) Notwithstanding subparagraph (A), a landlord or agent of a landlord who violates this section shall not be liable for statutory damages if the tenant provided documentation of the crime or act to the landlord or the agent of the landlord pursuant to paragraph (4) of subdivision (b) only.