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CITY OF <br />5y Ni, A <br />TA N <br />PROJECT <br />T <br />PROPOSAL <br />(ADDENDUM ONE — JULY 22, 20196) <br />ctil l tt "f'ilEt'4l.ICENSING ,SND I2t3 91Siit STIDt `5`t A'fEMFNT <br />The undersigned contractor, or corporate officer, declares under ;penalty of perjury that <br />helshe and all hisJher subcontractors are registered with the State of California <br />Department of industrial Relations (DIR), and that the fallowing is true and correct. <br />Contractor's <br />Name: ' 1,- V1 'ya = cw <br />Business <br />Address: <br />Business E -Mail <br />Address: _T) % t� t? <br />�... !� j��a P.,J psi• ,t~�t�,,�"> C..�;�a�� <br />Telephon <br />a: C - Et1 Ci 3t <br />State Contractor's License No. and fir, <br />Class: <br />License Expiration <br />Date: <br />2, i int r 0� <br />State Dept, of Industrial Relations <br />(DIR) Registration No.: It P c r y <br />State Dept. of Industrial Relations <br />(DIR) Registration Zporation Date: ? L � <br />Signed <br />Title: to t µ t 1 <br />City of Si nVa Ana { Pfojoc. 16-6461 Santa F..€iar�;kr€t �#�iyt"I Dvwsioti Prtijod i RF81D Octcher i, 'J 16 <br />23A-11 <br />