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COSTA MESA BUILDING -SAFETY DEPARTMENT
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P.O. BOX 1200. COSTA MESA, CALIFORNIA 92626
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DATE
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ADDRESS-
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OWNER HELTZER'ENTERPRISES-BROOKVIEW
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ADDRESS 740 N. La Brea Avenue
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CITY LOS An �eles CA 90038 NOL 937-2171
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LENDER United California Bank
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BRANCH -Main Branch
OWNER -ADDRESS
600 S. S rin St. 'L A
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.ALUEARCHITECT
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ENGINEER Fields & Silverman N 65 -0 0
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ADDRESS 113 N. Sari Vicente Beverl Hills
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APPROVED -'
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CONTRACTOR GeOr e- J-. HeltZer
By '' "--" DATE
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ADDRESS' '.740 N. La Brea Avenue.
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TEL.
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NO.OF USE OF NEW& cEWjDO
3-Cn PLAKS Z BUILDING
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CITY Los Aneles,,,CA NO.
STATE- .CITY
'YARDS APPROVED YARDS APPROVED
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LIC. NO. 3144 - - UC. NO. _
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SIZE NO.OF BLDGS.
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OF LOT ' S' ' NOW ON LOT None
IVT FT.
USE OF
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EXISTING BLDG..
.7 DLT FT.
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SIZE OF _ No' OF
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NEW BLDG. "'- ROOMS STORIES 2
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FT.
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COVERING Plaster
COVERING Wood
REA R'1' L p FT
FT.
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USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
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MAIN BLOCS.
ACCESS. SLOGS.
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APPROVED
APPROVED
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I hereby acknowledge that I have read this eDPlitation and state
that the above information is correct and agree to comply with
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all laws regulating building construction, and 1 shall not employ .(
any person in violation of the workman's compensation laws of
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the State of California.
I hereby certify that I am properly licensed as a contractor under '
;.THE AMOUNT SHOWN UNDER VALUATION IS -FOR
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the Stat. of California Business and Professions Code, Division 3,.
Chapter 9, and that such licensee are In full force and effect, or 1 -
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provI ions of the State of California Business
VALUATION .. - "zz F
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and Professions Code, Divi n 3, Chapter 9.
- PERMIT FEE $ g
Signature of
Permittee ''^ Li %
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$�< PLAN CHECK_ -`i
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'Authorized Agent 'v ,' r - y
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