Laserfiche WebLink
CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 16-1305 <br />3'm AND BUSH RESTROOM <br />CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT <br />The undersigned contractor, or corporate officer, declares tinder 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: CA lat> 2- Clt w c 1 <br />t1 t IA -X-" <br />0out _ <br />Business E -Mail Address: �oWr C!\o rn o <br />u Ic vC t S <br />c 1 Yvt c t i 1 <br />C c r✓i <br />Telephone: S(.2 � G G. 2q i C) <br />State Contractor's License No. and Class: 616 v C)o 3 -- 6 <br />License Expiration Date: f3l3/ll <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: <br />State Dept. of Industrial�ielations (DIR) <br />Registration Expiration] ate: (.0 lqoli6 <br />Signed: <br />Title: / Vf t e ��FG,t)64,7,-1- <br />P-4 of P-16 <br />