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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT IERVING <br /> janwe Cuibwloon, Pros. GtyofLodi <br /> Patricia E. vannuccl, Sea'y. 1601 East Hazelton Aaenue. P. O. Box 2009 San Joaquin County <br /> Tommy ,Joyce City of Escalon <br /> Earl Plmentol Stockton, California 95201 City of Manteca <br /> Fern Sugb oo 209/466-6781 kton <br /> Daniel L. Flores City <br /> oof f SSttocckton <br /> John J]. Most, M.O. City of Tracy <br /> John 0 J. Wade Jogi Khanna., M.D.. M.P.H.. District Health Offlcer San Joaquin County <br /> WilliSan Joaquin County <br /> Mary Anna love <br /> ' I <br /> ENV1R`C1."V:tE,,Ta1_ HEALTH <br /> FERMIT/SERVIC1=S <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE <br /> In order to comply with State and Local Laws relative to contractor licensing and <br /> Workman's Compensation Insurance requirements, we are asking that your provide this <br /> District with the information requested below. Please answer all of the questions <br /> and return the original of' this letter in the self-addressed envelope provided. <br /> Ron L. Valinoti , Acting Director <br /> Environmental Health Division <br /> BUSINESS NAME GARNER CONSTRUCTION <br /> BUSINESS ADDRESS 7900 wren Rd . CITY Oakdale ca . ZIP <br /> BUSINESS TELEPHONE NUMBERS (1) ( 209 ) 847-3480 (2) (415 ) 930-6288 <br /> OWNER(S) (1 ) Richard Garner (2) <br /> OWNER(S) ADDRESSES (1) 7900 Wren Rd . , Oakdl 1)e, Ca . <br /> OWNER(S) PHONE NOS (1) same as above (2) <br /> CA. , CONTRACTOR LICENSE NO.441a68 ISSUE DATE EXP- DATE n <br /> LICENSE CLASSIFICATION (A,B,C) A-3 IF "C" INDICATE SPECIALITY NOS. <br /> IF "C-61" CLASSIFICATION, INDICATE TYPE/S OF LIMITED SPECIALITY/ IES. <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING? YES xx NO <br /> IF 'YOU ARE SUBJ€CT'TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES X NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES ANO <br /> IF YES. EXPIRATION DATE <br /> SIGNATURE <br /> TITLE f -- 1 <br /> DATE <br />