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-,,'SANTT <br />NA,',ri[]ffi <br />DocuSign Envelope lD: 84ED4'l 82-54C3-40C6-8673-9D73C61 FFD5F <br />Planning and Buildlng AgencY <br />Plannlng Dlvlelon <br />20 Clvlc Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA 92702 <br />(714) 647S804 <br />rYrrw.Santa€na.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please tum in this form peftificate <br />Company Name (Print):I q t t rtul <br />Contact Name:)orj <br />Address address):Z.t4 A <br />City:aPhone No.\l o tott - ?Q Yu. E-mair Address: <br />-/Ef Change of Property Owner VCtrange of Occupant E Ctrange of Use f] Additional Occupant <br />t. The folloying <br />{om"" <br />best descrlbes my operatlon: <br />only D Retail Sales E MedlcaUDental <br />I warchouselmanufacturlngtDlstrlbutlon n ReatauranuTake out Food <br />fl Other (descrlbe) <br />2. Please provide a brief description of how the business operates at this site (for example, please <br />describ6 the general nature oi the business, what actjvitiesoccqr on-site, the hqurp of oqeratioT' <br />openrothefubrc). WA t{Src U\\,1?u.l.rl5 5 AnOu-l C*lt.orr\5, \ / <br />V-\,.t)r,Ls tw?rrrt pQolr ca((l' N; q-crhr,hrl on-s'k <br />3. rnnat *,"i ffi" io-Er)type of businesC or &se of facility? (Please crrltacl the,teasirp agent or building L <br />ownerto determine piorbusiness use') yy, <br />pro DA % tt^ari J*tr f&w'\n<4. h"r g{" Uuirdinb6r sfiice OrienVacant oiE this a new building? Yes ! t'to Elz <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes { *o A <br />6. Location of the businegs and suite number:t/t 9+a (S <br />tr ldfloor E 2r'dfloor fl <br />-noor7. Do you share the floor or business entrance with another businesS? Yes n No ,ZI- <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />fl looo/o tr 5oo/o f1 3oo/o <br />lf other than 100%, how is the remaining space used? <br />S: Planning\ClericalCounter Forms\ <br />Cofo Questionnai n 08-27 - 1 I <br />tr Lessthan30% <br />zipt ? 770 / <br />I <br />Aao s,4.