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CITY <br />PROJECT�' SANTA <br />'i <br />16-6467 <br />SANTY. 4 M .. <br />(ADDENDUM ONE — JULY 22t 016) <br />L0N`rRAC'Tt)IV% LICENSING AND RI GISTRATION STAT ENLENT <br />The undersigned contractor, or corporate officer, declares under penalty of perjury that <br />hefshe and all his/her subcontractors are registered with the State of California <br />Department of Industrial Relations (DIR), and that the following is true and correct. <br />Contractor's <br />Name:'! <br />Business <br />Address:C' <br />Business E -Mail <br />Address: l 1 <br />Telephon <br />State Contractor's License No. and <br />Class: , 2> t <br />).=7 / _:,�# / C.t�1 kle, <br />State dept. of Industrial Relations <br />(DIR) Registration No,: , <br />State rept, of Industrial Relations <br />(DIR) Registration Bx, iration Date: c� o ;)c- 7 <br />1._4 i.p <br />Signed <br />Title: t} f? E �j Cs k�' 10 <br />firm#y of Santi Ana 1 Prtajec; 16-64517 `arv(a An ?T1al Diversion Prujod I }3['!31[3.,. ot-tatier 7.:)()j(a <br />