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O_, OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT <br />FACILITIES DEVELOPMENT DIVISION <br />14 <br />SPECIAL INSPECTORS <br />Provide Following Information for Each Special Inspector Employed by the Agency (Attach <br />additional sheets if needed) <br />*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required <br />Inspector's Name <br />Certification/ <br />License Type <br />Certification/ <br />Licensing Agency <br />Certification/ <br />License Number <br />Expiration Date* <br />Comments <br />Fireproofing <br />ICC <br />5320836 <br />2-16-2018 <br />Correct Exp Date <br />Reinforced Concrete <br />ICC <br />5320836 <br />2-16-2018 <br />Correct Exp Date <br />Jeffrey Diaz <br />Soils <br />ICC <br />5320836 <br />2-16-2018 <br />Correct Exp Date <br />Masonry <br />ICC <br />5320836 <br />2-16-2018 <br />Correct Exp Date <br />Masonry <br />ICC <br />1106095 <br />1-18-2020 <br />Kim Byrd <br />Welding <br />ICC <br />1106095 <br />1-18-2020 <br />Reinforced Concrete <br />ICC <br />1106095 <br />1-18-2020 <br />Prestressed Concrete <br />ICC <br />1109095 <br />1-18-2020 <br />Masonry <br />ICC <br />5114248 <br />6-13-2017 <br />Troy Degener <br />Welding <br />ICC <br />5114248 <br />6-13-2017 <br />Reinforced Concrete <br />ICC <br />5114248 <br />6-13-2017 <br />Fireproofing <br />ICC <br />5114248 <br />6-13-2017 <br />High Strength Bolting <br />ICC <br />5114248 <br />6-13-2017 <br />Masonry <br />ICC <br />5077705 <br />7-20-2019 <br />Welding <br />ICC <br />5077705 <br />7-20-2019 <br />Eric Kennedy <br />High Strength Bolting <br />ICC <br />5077705 <br />7-20-2019 <br />Reinforced Concrete <br />ICC <br />5077705 <br />7-20-2019 <br />Prestressed Concrete <br />ICC <br />5077705 <br />7-20-2019 <br />Masonry <br />ICC <br />5006860 <br />9-13-2017 <br />Correct ICC ID <br />Prestressed Concrete <br />5006860 <br />9-13-2017 <br />Correct ICC ID <br />Robert Carman <br />Welding <br />ICC <br />5006860 <br />9-13-2017 <br />Correct ICC ID <br />Reinforced Concrete <br />ICC <br />5006860 <br />9-13-2017 <br />Correct ICC ID <br />Fireproofing <br />ICC <br />5006860 <br />9-13-2017 <br />Correct ICC ID <br />Masonry <br />ICC <br />1066095 <br />1-2-2020 <br />Prestressed Concrete <br />ICC <br />1066095 <br />1-2-2020 <br />Dennis Brown <br />Welding <br />ICC <br />1066095 <br />1-2-2020 <br />Reinforced Concrete <br />ICC <br />1066095 <br />1-2-2020 <br />Masonry <br />ICC <br />5223743 <br />1-24-2019 <br />Jesse Maddox <br />Welding <br />ICC <br />5223743 <br />1-24-2019 <br />Reinforced Concrete <br />ICC <br />5223743 <br />1-24-2019 <br />Masonry <br />ICC <br />1026139 <br />5-14-2019 <br />Reinforced Concrete <br />ICC <br />1026139 <br />5-14-2019 <br />Vartan Deirdeirian <br />Prestressed Concrete <br />ICC <br />1026139 <br />5-14-2019 <br />Shotcrete <br />LA City <br />P009633 <br />na <br />Special Inspectors with expired license shall not be permitted to perform Special Inspections. <br />"Access to Safe, Qualitv Healthcare Environments that Meet California's Diverse and Dvnamic Needs" <br />OSHPD <br />STATE OF CALIFORNIA — HEALTH AND HUMAN SERVICES AGENCY <br />OSH-FD-OPAA-100 (6/24/2016) <br />3/28/2017 <br />OPAA-0010-16 <br />Page 15 of 19 <br />