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Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print):bzeAtc aruE <br />Contact Name:Toa Ku aia <br />,,,*SAJ{TA <br />NA-','1,[]ffi <br />Planning and Building Agency <br />Planning Division <br />20 Civic Genter Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(7141647-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Address (business mailing address)Zo3 t E. l'4 S'trz^tEf unie A t <br />City:Sanh Ano State: LA q21 <br />Phone No q+4 353 360t+ E-maitAddress r <br />E Cnange of Property Owner [[ Cnange of Occupant E Change of Use E nOOitional Occupant <br />1. The following best describes my operation: <br />E orice only [l RetailSales E Medical/Dental <br />! Warehouse/Manufacturing/Distribution E Restaurant/Take Out Food <br />E Ottrer (descrlbe) <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 activities occur on-site, the hours of operation, <br />opentothefublic). kail fulat o+ e4v€n!€nt tt ,Q5 /ie .rrtu(Ft <br />Eoda, Ciqarr;4f<5-4 ctr;is €to{ o-Pr.t.t? fr,c p,tbliol aad- ft< fioursfr ortta4w Will (at7'bt* rrroo{t, br4w4;7onana /o?*t <br />WHat w6s the former type of buSiness or use of facility2 (Please contact the leasing agent'or building <br />ownertodetermine prior business use.) Cen ucnte4f )]pt e (rCAil) <br />Has the building or space been vacant or is this a new building? Yes X[ No n <br />2 <br />3 <br />4 <br />lf vacant, for how long?5 rtto4ths <br />5. Are you an independent contractor? Yes ( No E <br />6. Location of the business and suite number: <br />X 1",floor n 2ndfloor ! _floor.- <br />7. Do you share the floor or business entrance with another business? Yes E f.lo 4 <br />8. What is the amount of square footage leased? I Z CZ <br />9. How much of the space, which you lease, is office? <br />tr 1oo% tr 50% tr 3oYo tr Lessthan3o% <br />v lf other than 100%, how is the remaining space used? <br />Fo' Dartl tV r€ca?l {Tleak^Jk'' <br />S: Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27-1 8 <br />ZoZt E.t,'+rcct&otq' ,uorf AI