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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
or lican to Fill in Co pl ly a
BUILDIN j
ADDRESS
HE TZE -BR00 I
OWNERMAIL
ADDRESS 740 N. La Brea Avenue
TEL. 213 -
CITY Los Angeles, CA 90038 NO.
CONSTRUCTION
LENDER United California
BRANCH Main Branch
ADDRESS 600 S. $
ARCHITECTTEL.
OR ENGINEER Fields & Silverman N -
ADDRESS 113 N. San Vicente B r
CONTRACTOR
ADDRESS 740 N. La Brea Avenue
TEL.
CITY Los Angeles, CA 90038 NO.937-2171
CITY
STANo. 3144
LIC. NO.
S1ZE
NO. OF S
OF LOT
NLOGS.
NOW ON LOT one
USE OF
EXISTING BLDG.
SIZE OF NO. OF
2
NEW BLDG. ROOMS STORIES
EXTERIOR WALLP 1a
RO OF
Wood
COVERING St er
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Reside tial
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shell not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the Stare of"fifornia Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the rovis. ns of the State of California Business
and Professions Code, Divi 3, Chapter 9.
Signature of /
`
Permittee /
_3141c
Authorized Agent 57
APPLICATION FOR BUILDING PERMIT
BY ATE REC I D DATE ISSU
y- A
(( 11
O.P. NO_I`t-�"��t-n3.IIt 14 11 "W"
fi,RM _
TR
OWNER
BLOCK
APPROVED
BY
DATE
40,NE{�
NO. OF -2-
USE OF NEW S (A,.1S
�K
PLANS
BUILDING
YARDS APPROVED
YARDS APPROVED
I
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/L STREET.)
VAR.+
C. U.P. + �C -
APPROVED
VALUATION
$ / �L/!
FT.
BET. MAIN &
ACCESS. BLOW.
DATE �`
APPRnVFn A" -26
TOTAL FEE
7 -AX
0
VALUATION IS FOR
A PERMIT FEE ONLY: _ U1
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