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Plannlng and Bulldlng Agoncy <br />Plannlng Dlvlslon <br />20 Clvlc Center Plaza <br />P.O. Box 1988 (M-20) <br />SantaAna, CA92702 <br />(714) 647-5804 <br />www.ganta-ana.org <br />CERTIFICATE OF OGGUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />C"O'SANTA <br />NAfi{il$ <br />Please tum in this completed form your Certifrcate of Occupancy arylicatlon. <br />Cornpany Name (Print): <br />Contact Name: <br />Address(buslnessmalllngaddress): l'23? ,Q / r t, - <br />city: €a-u *4 ?tn. 4 state: (4. t ztpt 7 7-7O 7 <br />Phone No.:7/ ? ZDd 56 6'/ E+nailAddress ' o "cbt/<il Change of Property Owner E Change of Occupant ! Cnange of Use E Addltional Occupant <br />1. The following best descrlbee my operatlon: <br />I Otnce Only ! Retallsales n Msdlcal/Dental <br />! ttYarehouso/ilanufacturlng/Dlstrlbution E RestauranUTake Out Food <br />dotn"r(descrlbe) foca.rt *f Sctotl <br />Please provide a brief descrlption of how the buslness operates at thls slte (for example, ploase <br />describe the general nature of the business, what activltles occur on-site, tho hours of operatlon, <br />open to the public). /Oty+ fieP, <br />3. What was the former type of business or use of facility2 (Please contact the leasing agent or building <br />owner to detormlne pdorbusiness use.) fiean+y Sdrfuc4. <br />2 <br />4. Has the building or space been vacant or is this a new bullding? Yes E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes n fto Q/ <br />6. Location of the business and suite number: <br />S roroo,, tr 2trfloor fl <br />-floor7. Do you sharo the floor or business entrance with another business? Yes ! Uo ft/ <br />8. What ls the amount of square footage leased? <br />uo,ft <br />I <br />S :Plannlng\ClericaFCountor Forms\ <br />CofO Questionnalro 08-27-'l I <br />Ho* r,r/n of the space, which you lease, is office? <br />/U looo/o tr 5oo/o tr 30% <br />lf other than 100%, how is the romaining space used? <br />I Less than 30% <br />t