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,--SANTA <br />ANA,',lilIffi <br />,,I <br />Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA.92702 <br />(7141 647-5804 <br />www. santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />P/ease turn in <br />Company Name (Print) <br />this completed form with yo u r. Certifi cate of O cc u pa n cy a p pl icatio n. <br />I or-r/.-.-, Q l,/fuContact Name <br />Address (business mailing address): <br />City: <br />Phone No.: <br />4 <br />S:Planning\Clerical-Counter Forms\ <br />CofO Ouestionnairc 08-27 - 1 I <br /># <br />xate: (4 zip: 4OZl / <br />14 ' trt ' 1@8,' t', /E-mail Address <br />1 <br />2 <br />3 <br />change of Property o*n", A(cnange of occupant E Change of Use Additional Occupant <br />lf vacant, for how long?4'L w*4,1 <br />5. Are you an independent contractor? Yes E *o V/ <br />The following best describes my operation: <br />E ottice only I Retail Sates {Medical/Dentat <br />E Warehouse/Manufacturing/Distribution E RestauranUTakeOutFood <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, what activitieE occur on-site, the hours of operation, <br />open to the public). -flwficiax |n4r.z ( ?*^ flzua6aar4) <br />What was the former type of business or use of facility? (Please co-ntact the leasing agent or building <br />owner to determine pior business use.) (birOpf"r_h-C OM aZ <br />Has the building or space been vacant or is this a new building? Yes ff ruo tr <br />6. Location of the business and suite number: <br />8. What is the amount of square footage leased?t asb* A. <br />I u0 lro, & <br />4z+or[-X 1ofloor. tr 2ndfloor n floorI- <br />7. Do you share the floor or business entrance with another business? Yes E No n <br />9. How much of the space, which you lease, is office? <br />tr 1oo% tr so% F 3oo/o <br />lf other than 100%, how is the remaining space used? <br />d*Xiry n/a, @ /7ta_ <br />tr Less than 30% <br />t) f@ t, ;) l cl)rz- <br />33 /