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Plannlng and Bulldlng Agency <br />Plannlng Dlvlelon <br />20 Clvlc Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CAg2702 <br />(71 4) 647-5E04 <br />www.Santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn ln this completed form with your Ceftificate of OccuqncY <br />Company Name (Print):nl4- <br />Contact Name <br />Address (business mailing address):JAI. <br />City:I r-r State:-Q\- zp: 9f, l?A <br />Phone No.:1r.l 4t l^E+nail Address: <br />! Cfrange of Property Owner I Change of Occupant E Change of Use I Additional Occupant <br />1. The followlng best describer my opcratlon: <br />! offlce only fl Retailsales fi Medlcal/Dental <br />il WarehouselManufacturlng/Dlatrlbutlon D RestauranUTake Out Food <br />fl ottrer (dercrlbe) <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, <br />Ao/,c+L Cl '^, t- <br />artt) Fi. t-l ?" e-t' <br />the hours of operatlon, <br />open to the Publlc).c 'Drut), d,n q <br />&\-a, 5p.rv$,-a;?rc ,51 <br />i'\c !c cl- <br />4. Has the building or space been vacant or is this a new building? Yes E[ ruo D <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes D No E <br />6. Location of the business and suite number:eoo r L l7,r<'t' -1>{.P AD q <br />! 1nfloor ! 2"afloor tr <br />-floTT. Do you share the floor or business entrance with another business? Yes E t'to El <br />8. What is the amount of square footage leased?3 L{Dq <br />9. How much of the space, which you lease, is office? <br />n 100o/o E 50o/o D goo/o n Less than 30% <br />tf other than 100%, how is the remaining space used? i\e.l .ca-( Exarr fioorrr9 <br />ANA <br />?IIN\C <br />IBlltDlu <br />Il]t\(I <br />*,,SANTA <br />SrPlanning\Clodcrl4ountcr FormE\ <br />CoiC Ouo3tronnalrc 0&27-18 <br />\-t I ?l -Tr,',.,t) <br />'P',1t,l <br />omertodet*mlrc Prior <br />What