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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 16-6461 <br />WARNER INDUSTRIAL COMMUNITY WATER AND SEWER IMPROVEMENTS <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 <br />Industrial Relations (DIR), and that the following is true and correct. <br />Contractor's Name: <br />Business Address: 1 Gig 'I"`. h✓11��A1 �1�+4Q/NaJ �LI�L'h9.�-, C' I2�t�0 <br />Business E -Mail PLOc4e0 o ��✓ty7 I I h t Cho �A <br />Address: 1�/'1ld9l Z, Gcal"+k <br />Telephone: Q I �-{-+ ±26 <br />State Contractor's License No. and Class: 4 �6_7 <br />License <br />Expiration Date: <br />State Dept. of Industrial Relations (DIR) <br />Registration No.: o 000 C) 0 <br />State Dept. of Industrial Relations (DIR) <br />Registration Expiration Date: r1 <br />Signed: �6L_- LaCy—E� <br />Title:51� y'1 <br />P-6 OF P-17 <br />