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Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA927O2 <br />(714) 6475804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please tum in this complefcd form with your Ceftificate of Occupncy application. <br />company Name (print): t, , pe < Vt>5 Dt-nTftt - PRAcTTC? oF 1t1frtfffi Df,ftfl <br />TNC <br />Contact Name hr?- 4HrcsTilE- (ttan DTfr/1/ <br />Address (business mailing address)4nz E, FrRSi- 9TREtr-* Zft <br />City:S,fttvT+ ^^r <br />1. The following best describes my operation: <br />tr <br />tr <br />Ofiice Only E Retai! Sales MedicaUDental <br />on E RestauranUTakeOut Food <br />! 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 />opentothepublic). Deff+ otrFICeJ RL=tft7eD uSA-€ . ^.mr.T (lr ftt.t fu.Frr,n 1;o0an-/"oo/: t:h fr'tf"Te^3. What was the former type of business or use of facitily? (Please contact the leasing agent or building <br />ownerto determine pior business usa.) <br />P*y lEss 1iloe <br />X4. Has the building or spare been vacant or is this a new building? Yes NoE <br />lf vacant, for how long?nf <br />5. Are you an independent contractorZ Ves f,No fI <br />6. Location of the business and suite number:\/p\ lstfloor tr 2dfloor ! <br />-floor-\ <br />7. Do you share the floor or business entrance with another business? Yes n No X' <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />(100o/o tr so%tr 3oYo <br />lf other than 100o/o, how is the remaining space used? <br />S :Phnning\Clerixl'Counler Forms\ <br />CofO Quedionnaire 0&27-1 8 <br />Less than 30% <br />,,-SANTA <br />NA,'iffii <br />swe lft zip: ?)7A I <br />Phone No., (Kt?) <23-76)( E-maitAddress: C<JerL{s. €t7 ,.na' l' Lc,.\U <br />E Change of Property Oruner EI Cnange of Occupant fl Cnange of Use E ROoitional Occupant