Laserfiche WebLink
Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print)DCIA Enterprises, lnc. dba Kefir Mix <br />contact Name: QuYnh NguYen <br />CTI*SAI{TA <br />Al,{Ar}iilffi <br />Planning and Building Agency <br />Plannlng Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(714) 647-s804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Address (business mailing address)15051 Humphrey Cir, <br />City:lrvine State: cA Zip 92604 <br />PhoneNo.: 714-725'2149 E-mailAddress: kefirmix.us@gmail.com <br />! Change of Property owner n Change of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />E Omce only fl Retailsales fl ltledlcal/Dental <br />E Warehouse/Manufacturlng/Distrlbution I RestauranUTake Out Food <br />! Ottrer (describe) <br />2. Please provide a brief description of how the business operates at this site (for example, please <br />describe the general nature of the business, what activities occur on-site, the hours of operation, <br />open to the public). <br />Our main operation consists of preparing/selling kefir yogurt drinks to direct consumers to enjoy off premise. <br />Our planned hours of operation is M-Th: 11:30 AM to 9 PM and F-Sun: 11:30 AM to 10 PM <br />3. What was the former type of business or use of facility? (Please contact the leasing agent or building <br />owner to determine prior business use.) <br />We are currently using the facility as a boba tea house. We are keeping it the same except we will now sell kefir <br />yogurt rather than boba and tea. <br />4. Has the building or space been vacant or is this a new building? Yes ! No I <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E No I <br />6. Location of the business and suite number: D <br />I l"tfloor tr 2nd floor floor <br />7. Do you share the floor or business entrance with another business? yes E No X <br />8. What is the amount of square footage leased?1200 <br />9. How much of the space, which you lease, is office? <br />! looo/o tr soo/o tr 3oYo Less than 30% <br />lf other than 100%, how is the remaining space used? <br />To prepare drinks, sitting area for guest. <br />S:Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27-1 8 <br />tr <br />I