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38100
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Annlicant to Fill in Completely A
BUILDIN rte"'/e"'ltp
PDDRESS � :il
OWNER HELTZER ENTERPRISES-BROOKVIEW
MAIL
ADDRESS
CITY Los
740 N. La
TEL.
CA 90038 NO. 937-217:
LENDER` United California Bank
BRANCH Main Branch
DRESS
ADDRESS113 N. San Vicente, Beverly Hills
CONTRACTOR George J. Heltzer
ADDRESS 740 N. La Brea Avenue
TEL.
CITY Los Angeles, CA 90038 NO. 937-2171
STAE CITY
LIC. TNO. 3144 LIC. NO.
512ENO. OF SLOGS.
OF LOT I NOW ON LOTNnne
USE OF
EXISTING BLDG.
SIZE OF NO. OF
APPLICATION FOR BUILDING PERMIT
REC'MED By IDDATE RE�CEEIV D
�((
DATE ISSUED
PERMi
BUILDING
ADORES I
L
nn `I
TRACT V� T
LOT
BLOCK
NEW
IADDIALTER
REPAIR
OWNER
VALUE
USE S
FIRE
DATE
'ONE NO. OF USE OF NEW U1 Cpl
PLANS BUILDING GO
YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDI
FROM C/L STREET)
USE OF BUILDING AND WORK TO BE PERFORMED
Redential
DISTANCE BET.
MAIN BLDGS.
BET. MAIN &
ACCESS. SLOGS.
R +
DATE �j
APPROVED17
APPROVED
tC=
I hereby acknowledge that I have read this application and nateFPURPOSE
that the above information is correct and agree to comply withf T
all laws regulating building construction, and I shall not employ\ y
any Person in violation of the workman's compensation laws ofTAX r
the State of California. / - m
O. FT. O
I hereby certify that 1 am properly licensed as a contractor underthe State of California Business antl Professions Code, Divisicn 3,UNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl that such licenses are in full force antl effect, or IE OF ESTABLISHING A PERMIT FEE ONLY:am exempt from the provisions of the State of California Businessand Professions Cotle%[L/l/Y,ion 3, ChapterfJ9.PERMIT FEE SSignature ofE^. z`- /./!�'-`I - NPafmittee i' ;'J/ PLAN CHECK S /+ E
Authorized Agent N o
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