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Building Safety Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702(714) 7-54L5 <br />tltww.santa-ana.org <br />Request for Temporary <br />Ceftificate of Occupancy <br />Project Add ress V*4 a 3,=- <br />Business Name , "+r^ 4*'-)B u ild ing Use <br />Business Owner's Name -!I("Ppnon"Qsr rtq-+obt <br />Applican <br />Address <br />t's Name/?co\o \-\rrh,ry\tu\ ilk. AqD {.rCI"^i[ao , cA q}s1r\ <br />lf occupancy is partial, specify location. lnclude SiteiFloor Plan <br />Cff\ O <br />lf approved, the Temporary Certificate of Occupancy (TCO) will become void after 30 calendar days of date <br />of issuance; at which time a permanent Ce(ificate of Occupancy will be granted or occupancy terminated. <br />There is no renewal process for this request. The applicant is aware that Section 109.1 of the California <br />Building Code indicates, in part, that no building or structure shall be used or occupied until the Building Official, <br />or authorized representative, has issued a Certificate of Occupancy. Failure to obtain a Certificate of <br />Occupancy, or terminate occupancy at time of expiration of TCO, may result in criminal prosecution. <br />lnitials \- f <br />The applicant understands that the fee is not refundable, even if the request is denied. The request for <br />Temporary Certificate of Occupancy does not grant any utility service release. lnitials UJ yyl <br />The applicant hereby agrees to hold the City of Santa Ana, its officers, and employees free and harmless from <br />any incidence or occurrence, which may occur as a result of this TCO. lnitials W$\ <br />Applicant's Sig nature Date \! \Cl?op* <br />Bldg Permit No lofl7lz4 <br />Total Area of Building_sf <br />Releases Okay Date <br />lt -)5 - tZ-B u ild ing 4. <br />P lu m b ing/Mech a n ical J <br />1,o <br />7 <br />Electrical <br />Fire <br />Police <br />Planning <br />Public Works <br />Occupancy <br />Received Date <br />Expiration Date <br />tl-\6 - t2-Approve 6g21s ll --lrc - r-l Denied Date t-r./*- <br />\n <br />s-s <br />oI <br />\J- <br />12-t1-,,2-Notified <br />Offici4_s Signature lssue Date: ll '11 - t 2--, <br />Certificate of Occupancy Reference No. <br />G G,., <br />TCO No.: DOL\2b <br />.--SANTA <br />NAJ}iltr <br />Reason for Request: <br />FOR OFFICE USE ONLY <br />$404.13 Fee <br />occupancy Group M <br />Approved Use_ <br />Tvoe of Construction it b. z.rPl-'' ------------ <br />Area to be occupied_sf