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t <br />I Planning and Building Agency <br />Planning Division <br />20 Givic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, C492702 <br />(7',t41647-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />*-SAI'{TA <br />ANA,'lt'ilffi <br />Please turn in this completed form with your Certificate of Occu pa ncy appl ication. <br />Company Name (Print)AJ <br />T <br />CNT <br />T-l.) <br />Contact Name:NJ \) <br />Address (business mailing address):2? 31 \r.t , F['flrt sr . tvtu tf A <br />City:6ANTA A$A State: CA Zip: <br />phoneNo.: 4..lq'qQ1-tj qV E-maitAddress: G.\\i f\t den <br />E Cnange of Property Owner E Cnange of Occupant E Cnange of Use E Additional Occupant <br />1. The following best describes my operation: <br />Bf Orice Only n Retail Sales n Medical/Dental <br />E Warehouse/Manufacturing/Distribution ! RestauranUTake Out Food <br />E Ottrer (describe) <br />Please provide a brief description of how the business operates at this site (for example, please <br />describe the general nature of the business, whaf.activities occur on-site,, the hgurs of operation, <br />open to the public). y4-(ll51rh v(,,(.t U 4tt 16 ,&,.hal bU,( J t ,t r$"'{N - - <br />rcsri on ho I attruni ly < 1a ce s r <br />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 />4. Has the building or space been vacant or is this a new building? Ves ( No E <br />lf vacant, for how long?Nt1d 4!Jr9- <br />5 Are you an independent contractor? Yes E No B. <br />Location of the business and suite number: (AN l.f A <br />tr lstfloor tr 2ndfloor ! <br />-floor7. Do you share the floor or business entrance with another business? Yes E No 6 <br />8. What is the amount of square footage leased?r,.J on/ € <br />9. How much of the space, which you lease, is office? ,J ) N A e etg. (a) <br />tr looo/o tr 50% tr 30% tr Lessthan3o% <br />lf other than 100%, how is the remaining space used? <br />S: Planning\Clerical-Counter Forms\ <br />r-il\96 <br />corn <br />2 <br />3 <br />6 <br />CofO Questionnate 08-27 -18