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BUILDING STANDARDS ADMINISTRATIVE DE APPENDIX <br />(Part i, Title 24, C.C.R.) <br />STATE OF CJiLXORMA FQE IN DEPARTMENT OF GENERAL SERVICES <br />OUPI.ICATE OFFICE OF THE STATE MCNREf:T <br />BUILDING INSPECTOR ' <br />QUALIFICATION RECORD F1i --~,,,,, <br />77f ip 7rpl I ~'~~~___ <br />PLEA E PRINT R TYPE _ <br />2. County <br />1. ttAME <br />W[ Fins Midtlb 3. SMOOI Oinrin or Ovmer <br />' ADDRESS _- <br />NweWr Sveet •. 14gen Name <br />f:Ay ~- CourNT Sun ZIP Code 6 Euimeutl Ceet <br />at15alESS NOME <br />M10NE(~_ ~ MiONEI ~)_~~ <br />Area Cede Ane Lode / <br />-z_--- - <br />a. Meedatrw 7. Neeeysaee arMnYwrarwyeryelyeiealtlelKLar N.vqu.e«Been 6. Are youmenplerdtawacmr tw etwye Mrl&nyT <br />AAOreh DeY Yer w.a.tl rrttlt wraRrnerM wlieh rear •nPei Yern wwrq dlicwncYl <br />p YES p No ~ ~e tear en N» s.ur or ^ YES ^ No <br />/. An Yev niieMed in CAlilarrte w a Corrufrnlaf lrrepeew7 ^ YES ^ NO <br />R yK irtdlesp ystr CeltleMae llesineretl (:oerOylWlen Yttaenor RpMrdioA Rwnber, erd [lirsiw entl SPwenies m vNenr you ere repinend. <br />CaWerw Mehvnien NUeWer 6iyieierMel _ <br />a naienrM in Oieiten al Ytdiob epeaeldec <br />p T. Nenrenieef p 6. Cerrrb. stet. CerY ^ 8. H YAC p 11 Raofiq <br />p 2. Ewmld ^ 6. rurerreart p 10. Sven. Mwh ^ 14. Sven, cetl. <br />p 7. Carn.u ^ 7. P.eere p 11. Weldirq p <br />p 4. M~ ^ t. PYrmlirp ^ 13. Pipeene p <br />10. Liewetliratlen reletetlbblrldeq ereeeenen erer- GredreteT Peer <br />FdrtaYen - Nemes eM lerafiaro d made etwMM Lwl Corrnes Srudrd YES ~CeerOteted <br />er <br /> <br />11. tawgWEeerteynrnl RemrA.lrtt»FrM rnYeerw eanrdtyna.wpwaMns eeperWme•a mor.ePee is n..d.d ettece•eeeerea Peee•ryeu m.r relw bpeniew when <br />~. -- -- - .~.. w -- M r r <br />Mo.- rY . AAa Yr. Oauo.Ibm eM Deenfeuerr. d Duties hrlornfed Rwiwtl tlernee nd Addmb. Reeeem br I~irq <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Complete Application on Other Side of Sheet <br />Architects. Suttetural tfr other applicable Professional Engineers shalt forwent this rswrd as follows: <br />M Narthsrn Glilarnia. TD: In Southern Cal'rfornia. To: <br />Offip of The State Architect Office of The State Architect Office of Tha State Architect <br />P.O. floc 1079 7 Hawthorne Stroet, 4th Floor 107 S. Broadway, Room 3029 <br />Sacramento. CA 95811-1079 San Fronc'rsw. CA 94105 Los Angeles. CA 90012 <br />29 <br />2Z o~ 3Z <br />