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As required by the State of California Business and Professions <br />Code Section 7028.15, the undersigned swears under penalty of <br />perjury that he is licensed in accordance with the laws of the <br />State of California. <br />License No. 3. Class License expiration <br />date: <br />*Type of License: <br />yp [] Individual Corporation [) Joint Venture <br />Name of Individual Contractor <br />By. <br />Business Address: <br />min <br />Name of Partnership <br />By. <br />(PARTNER) <br />Business Address: --%C)3\ 2;�O� �1 <br />Names of Other Members of Partnership: <br />Address <br />Address <br />Name of Corporation <br />By: <br />By. <br />By. <br />Business Addresd: <br />(Signature o <br />Sign-ature 'of S <br />siden,t of Corporation <br />o��poration) <br />gnature of Tre&i§urer of Corporation) <br />To!�5on-,5, 3ivd� v- + a <br />Corporation organized under the laws of the State of <br />SEAL <br />* Check Applicable Box <br />PROPOSAL <br />Page 5 <br />