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CITE' OF SANTA A A <br />PROPOSAL <br />PROJECT NO.: 11-6413 <br />SA-5 VAULT MODIFICATIONS <br />CONTRA TOR'S LICENSING and REGISTRATION STATEMENT <br />The undersigned contractor, or corporate bificer, declares under penalty ,of perjury that lie/sloe <br />and all his/leer subcontractors are registered with the 5tat:e of California Department of <br />Industrial Relatim (DI , and that the foll6 inn 3s true and correct. <br />Contractor's Flame �, ' 5 m <br />a <br />Business. Address, _ <br />Business F-Mail <br />Address: Vim. <br />StateCo:r tractor's License �i o. a rid ia�s: ' ...� � � -- ' <br />License <br />Expiration Date. �� ��` , <br />State Dept. of Industrial Relations (0111) <br />Registradon No.., <br />State inept, of lndustri l Relations (DI'R) <br />Registration Ear 'ration late; <br />Sired. <br />`I-itle: <br />F-5 l <br />23A-14 <br />