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completed form with your Ceftificate of Occupancy application. <br />Ilt-rsrovr LLC <br />contact Name: O,lr^ Go y176-tut- <br />Please turn in this <br />Company Name (Print): <br />.,-*SANTA <br />NA-'li'i}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 />t <br />Address (business mailing address):1603 uJ 1{ StrecJ U, 'tw <br />Qtttce <br />A <br />Sc,-r^\c. An cACity:State: <br />Phone No E-mailAddress: I n <br />E Cfrange of Property Owner E Cnange of Occupant E Cnange of Use E Additional Occupant <br />1. The following best describes my operation: <br />E ottice only frRetail Sales E tuedical/Dental <br />E Warehouse/Manufacturing/Distribution n Restaurant/Take Out Food <br />E Otner (describe) <br />3 <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 />opentothepubric)' Ctoth a, gVoes/ Wfdne) co3yyu116S, <br />What was the former type of business or use of facility2 (Please contact the leasing agent or building <br />owner to determine prior business use.,) <br />( on- <br />2 <br />4. Has the building or space been vacant or is this a new building? Yes E ruo E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E No n <br />6. Location of the business and suite number: <br />f t't ftoor tr 2nd ftoor E <br />- <br />ftoor <br />7 . Do you share the floor or business entrance with another business? Yes E No IZ <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />tl 1oo% tr soo/o n 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 Questionnaire 08-27-1 8 <br />zip, q L+o 3 <br />"t^l fito-" (()4