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CITY Or SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16 -2668 <br />RIVERVIEW, CABRILLO & WINDSOR COURT RESURFACING <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that he /she <br />and all his /her subcontractors are registered with the State of California Department of Industrial <br />Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: ;4n Los Angeles Ave., Suite 11 5.420, Moorpark, CA 94021 <br />Business E -Mail Address: hn it ccpacificreuniscou�rts rom <br />Telephone: (818) 991 -7445 <br />State Contractor's License No, and Class: 940738 (gam, C_8) <br />-- License Expiration. Date: 01/31/2017 <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: ,. 1000010871 <br />State Dept, of Ind rial la 'a s (DIR) <br />Registration Expira on 06/30/2016 <br />Signed: s <br />Title: <br />P -5 of P -17 <br />23A -18 <br />