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-,.-SANTA <br />Ai,tA*[[ffi <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 />(7141il7-5804 <br />www.santa-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) <br />Contact Name: <br />Address (business mailing address): <br />City:State:_ <br />Phone No.E-mailAddress: <br />E Cnange of Property Owner E Cnange of Occupant E Cnange of Use n AOOitional Occupant <br />1. The following best describes my operation: <br />E Office Only ! Retail Sales E Medicat/Dental <br />! Warehouse/Manufacturing/Distribution E RestauranUTake Out Food <br />E Otfrer (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). <br />3. What was the former type of business or use of facility? (Please contact the leasing agent or building <br />owner to determine prior business use.) <br />4. Has the building or space been vacant or is this a new building? Yes E No E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E No E <br />6. Location of the business and suite number: <br />tr lstfloor tr 2nd floor fl _ floor <br />7. Do you share the floor or business entrance with another business? Yes E 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 />tr looo/o tr soo/o n 30% <br />lf other than 100%, how is the remaining space used? <br />S: Planning\Clerical-Counter Forms\ <br />CorO Questionnaire 08-27-1 8 <br />tr Less than 30%