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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT h` FACILITIES DEVELOPMENT DIVISION APPLICATION FOR OSHPD PREAPPROVED AGENCY (OPAA) For Office use only FOR STRUCTURAL TESTS AND SPECIAL INSPECTIONS OPAA — 0042-16 Approved Agency City County State ZIP Code Kleinfelder, Inc. San Diego San Diego CA 92111 APPLICATION TYPE / FEE New Application Fee Renewal Fee Application Type (Fees are Nonrefundable) (Fees are Nonrefundable) M Combined Testing AND Special Inspection Agency ❑ $1,000.00 ® $500.00 ❑ $500.00 ❑ $250.00 ❑ Testing Agency ONLY ❑ Special Inspection Agency ONLY ❑ $500.00 ❑ $250.00 APPLICANT INFORMATION Position in the Organization Applicant Name James L. 58ady Project Manager 9 Application Date Agency's Local Name 12111/18 Kleinfelder, Inc. Phone Number E-Mail jstiady@kleirfeldeocom 858-223-8500 Applicant certifies that all information provided in this application are accurate. Applicant Signature �f Address of Facility Location (Each facility location requires separate application.) Street 5761 Copley Drive. Suite 100 County State: Zip Code: City: San Diego CA 92111 San Diego Facility Mailing Address (if different from facility address above.) Same as above Street State: Zip Code: GIIY: KEY AGENCY PERSONNEL (Attach additional pages if needed.) Engineering Manager (or equivalent) -Name CA Registration Number Expiration Date 06130/2020 James L. Shady C66243 - GE2820 Phone Number Title in the Organization 58500 Project Manager II E-Mail FAX Number jstiady@kleinfelder.com 858-223-8499 Alternate to Engineering Manager (if any) - Name CA Registration Number Expiration Date C59908 12/31/2019 Chad Davis Title In the Organization Phone Number CoMET Team Leader 858-223-8500 Alternate Phone Number E-mail cmdavis@kleinfelder.com mac- a nr� -Access to Safe, Quality Healthcare Environments that Meet California's Diverse and Dynamic Needs STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY OSH-FD-OPAA-100 (0310l/2018) 516/2019 OPAA-0042-16 Page 1 of 19