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.^-SANTA <br />ANA/i[]ffi <br />Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, C492702 <br />(714) 647-s804 <br />www.santa-ana.org <br />CERTIFICATE OF OGCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />P/ease turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print):Tnz Rerr\ Car ( cz>wCta <br />ContactName: ,\i)r-trn C D'\ (ZtYrnPA <br />Address (business mailing address)2Aofr W tri{lh :,\ i)ni + t7 <br />City:3arn\o, M^ <br />phone No.: I Q+q\'ZtZz -Z!7> E-mairAddress <br />! Change of Property Owner E Change of Occupant E Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />! Office Onty ! Retail Sales ! Medical/Dental <br />! Warehouse/Manufacturing/Distribution E RestauranUTake Out Food <br />E 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 />opentothepublic). L\rrcr yc"y\11 ) t\rr,n<lrr. tepcl\y 1(_rwr y.LQzlty + cVl"rrl>.nlot': <'( t',y\y,,lrorr e.v( y.n,tk spn yr\t,",rl<v1 -lrrclcru_ <br />3. What was the former type of business or use of facility2 pteJase "ont""t*" basing agent or building <br />owner to determine pnor busrness use.) <br />A.-,,\.',a,',rt['rvt kQri,r ? lz.vvtcCi /4. Has the building or space been vacant or is this a new building? Yes $ No E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E *o S/ <br />6. Location of the business and suite number:ZKB W FiT+h Di. vntl \3 *.n\^ A^o CA <br />ff t*Roo,. tr 2ndftoor floor <br />7. Do you share the floor or business entrance with another business? Yes {NoE <br />8. What is the amount of square footage leased?\500 sl <br />9. How much of the space, which you lease, is office? <br />tr 1oo% tr so% tr 30% <br />lf other than 100%, how is the remaining space used? <br />lnr WarK',,,1 ov\ \-L.e VgUl.., LV.:, . <br />S:Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27- 1 I <br />M Lessthan 30% <br />state: CA zip: q Zno3 <br />Y* s\a&crletc"il @t d n 'l . ca,,2