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,--SANTA <br />ANA-"'t'[,]ffi <br />rA <br />Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(7141647-5804 <br />www. sa nta-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print)-4- n ,t'7r.^ o2i'a^ r Z/,Aa- c r, .Z^c-7- 7 U_ <br />Contact Name:r ,/ <br />Address (business mailing address); <br />-/i7zo/ D, 7,7(l (+4tta <br />cnv, Sarzh / t state: CA zip: 4L%f <br />Phone N".,@fi) L/? '3CZ? E-mairAddre ss: ?/qt,n 4 -Tfz/LnCUl- btt't- <br />! Change of Property O*n"r. ,( Cnange of Occupant ! Change of Use n Additional Occupant <br />1. The following best describes my operation: <br />fl Oti."Only ! Retailsales f] Medica!/Dentat <br />! Warehouse/Manufacturing/Distribution ! RestauranUTake Out Food <br />E Ottrer (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 />open to the public).' fiO t*itvt gc*nle - Br t*1* t (-ot [aA' on S <br />4. Has the building or space been vacant or is this a new buildingZ Ves ff No E <br />lf vacant, for how long? <br />3. What was the former type of business <br />owner to determine prior busrness use.) <br />5. Are you an independent contractor? Yes E <br />6. Location of the business and suite number: <br />1st floor tr 2nd floor <br />or use of facility2 (Please contact the leasing agent or building <br />W,r?rooAt crt*.< <br />No <br />fl _ ftoor <br />Ana, & <br />4z+of <br />tr <br />o <br />il7. Do you share the floor or business entrance with another business? Yes n No E <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />,/-n looo/o tr so% tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />Less than 30% <br />S: Planning\Clerical-Counter Forms\ <br />Cofo Questionnairc 0*27 -18 <br />,/' 0 ruoa.tLl <br />tr