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I <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 />(7141 647-s804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this completed form with your Cerlificate of Occupancy application. <br />Company Name (Print): <br />ContactName: hcnnc.,,n EH+vtsD- €a y\ \,,.,',J i\rrr',r) <br />Address (business mailing address) <br />\-l1r1!4 tu t sa- s-Fr__""* <br />City:Cz-',.V Cl nn Starc: G^ Zip lutot <br />Phone tto.:'lt'1-Sq\^o CI3 L E-mail Address: Yh,n {- Ao.nlr!(d arn",,l,o,-.-, <br />{ <br />"n"nn" <br />of Property Owner E Changeof Occupant I Change of Use E <br />1. The following best describes my operation: <br />E otlceonly E Retail Sales'tr"o,""l/Dental <br />fl Warehor"gnr"nrr"cturingloi;if'ution E Restaurant/Take Out Food <br />E Ottrer (describe) <br />3 <br />4. Has the building or space been vacant or is this a new building? Yes E <br />lf vacant, for how long? <br />-------!- <br />Additional Occupant <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 o! operation, <br />opentothepubtic). C-,Pt,r fi,T,rr, T , S^f-V c?2n f {-)u'b}'c <br />What was the former type of business or use of faci[ty? (Please contact the leasing agent or building <br />owner to determine prior business use.,) !6 ,.lrJ <br />*"F\ <br />5. Are you an independent contractor? Yes ( *" O <br />fi-,,,,, <br />6. Location of the business and suite number: <br />S--tottoo,. tr 2ndftoor !-ftoor <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?t(bc, '- [ a c'o S(v-T <br />9. How much of the space, which you lease, is office? <br />n 5oo/o tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />S:Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27-1 8 <br />Less than 30% <br />,--SANTA <br />NA*',[li]ffi <br />tr