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*-SANIA <br />NA-"'ffi <br />Planning and Building Agency <br />Building Division <br />20 Civic Center Plaza <br />P,O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />www.sa nta-a na. org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />I <br />- <br />Please turn in this completed form with your Certificate of Occupancy application. <br />companyName(print): Anqie llt,fi;h'o: C), hJ <br />Contact Name: <br />Address (business mailing address):qll N. Hr*rrhov n lul 4 D <br />City:State: C A. Zip OaTn? <br />Phone No.(l t,i,1,\f--8: 3 .!E-mailAddressw! Change of Property Owner fi Change of Occupant ! Change of Use ! Additional Occupant <br />1. The following best describes my operation: <br />E Ofice Only fl Retailsales E Medical/Dentat <br />! Warehouse/Manufacturing/Distribution E RestauranUTake Out Food <br />E Otner (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 />OPU {w,^ ? , A ,A4, -l-o <br />7 t. [r, *, ' <br />pttPnrh3 slu.l<e) o4Ll ko4 " <br />3. What was the former type of business or use of facility? (Please contact the leasing agent or building <br />owner to determine piol business use.) <br />FZ.*I hion tio fl,un7 <br />4. Has the building or space been vacant or is this a new building? Yes p No E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E No E <br />6. Location of the business and suite number: <br />R l"floor tr 2dfloor ! _ftoor <br />7. Do you share the floor or business entrance with another business? Yes E f.f o E <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />tr 1oo% ! so% K 30% <br />lf other than 100%, how is the remaining space used? <br />cm\cntr-frm\Supp. Quest. <br />07t2016 <br />tr Less than 30% <br />t' I