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-,-SANTA <br />ANA-'ql}ffi <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 />(7141647-s804 <br />www.sa nta € na.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />P/ease turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print):5 Ls L^vrLr..r C"e^\lo.,s LtoiJ <br />City: <br />Contact Name \r <br />Address (business mailing address): <br />4s\i^,, <br />9. How much of the space, which you lease, is office? <br />n fio% n so% tr 3oYo <br />lf other than 100%, how is the remaining space used? <br />S:Planning\Clerical4ounter Forms\ <br />State: Ch 710 qz"7g\ <br />E-mailAddress: a,rco-,1\ € I a./nAr,(.^6 anq,tr,{e"'tl, uS <br />il <br />fft""rthan 30% <br />Phone No.: 7/&/ - flt"V - LbLZ <br />fr Cnange of Property Owner E Change of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />! Orice Only E Retailsales ! ruealcat/Dental <br />! Warehouse/Manufacturing/Distribution ! Restaurant/Take Out Food <br />ffotner (describe) Lar n\., ,-r a V <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 6lublic).- Saif- inr.rtre \a'"n [ro",n'^\ ' ^{--S <br />17 - 1l30 <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 ! No { <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E No V <br />6. Location of the business and suite number U".,1 * <br />-/[ 1.,floor tr 2ndfloor ! _floor <br />7. Do you share the floor or business entrance with another business? Yes E No <br />8. What is the amount of square footage leased?2, 860 <br />CofO Ouestionnaire 08-27-1 8