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,--SANTA <br />ANAEIil$ <br />Planning and Building AgencY <br />Planning Division <br />20 Givic Genter Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(711\ 647-3e04 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this comPleted with <br />Company Name (Print):\ <br />application. <br />\\ <br />Contact Name ('.rln t.,,€h A-r44n*1.r^r- <br />Address (buslness mailing address):Zc1 ( -:<- sr- - 5-t+< lr 3t1 <br />City 9c.rtlr-, Aqq <br />Phone N".' (N\\ \1'\\ E-mairAddress: <br />State: 4.fl Zig- <br />ls"sssS\s{ni.\\Q ,qr,s\.\ssn <br />N <br />EI Cnange of Property Owner(Change of Occupant D Change of Use E ROOitlonal Occupant <br />1. The following best describes my operation: <br />I omce Onty I Retailsates E Medical/Dental <br />I Wareho use/M an ufactu ri n g/D Istri bution p(n".t", ranUTake Out Food <br />E Ottrer (describe) <br />Z. 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 />3 What was the former type of business or use. of facility? (Please contact the leasing agent or building <br />owner to determine pior business use.) [YVdiCo{ OFf4t< <br />Has the building or space been vacant or is this a new building? V"ffi No I4 <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes 'S No fI <br />6. Location of the business and suite number: <br />p(roooor. n 2dfloor fl <br />-floor7. Do you share the floor or business entrance with another business? Yes fl No <br />8. What is the amount of square footage leased? <br />9.How much of the space, which you lease, is office? N/n <br />n looo/o tr so% tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />S : Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 0&27-18 <br />tl Less than 30% <br />'i