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,--SANTA <br />NA-"i'ilffi <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 />(714) 647-s804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY : <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this form with your Certificate of application. <br />Company Name ( <br />Contact Name: <br />mailing ress)th< I 4 \r./{ <br />City:State r;o <br />phone r.ro., ?t q - L9q t9?9 e-mairAddress , Cto <br />ffi Cnrng" of Prope(y Owner E Cnange of Occupant E Cnange of Use E Additional Occu <br />T <br />1. The following best describes my operation: <br />n omce only ! Retait sales (ueaicatl <br />E Warehouse/Manufacturi ng/Distribution <br />E Otner (describe) <br />ranUTake Out Food <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 />3-;;[Ut4 N4,au-, Fn' ,9'ff 1e-{ <br />3. What was the fo;mer/tlpe of business or use of facility? (Please contact the leasing agent or building'v';::'fri:rr';:uessuse) <br />,4. Has the building or.O$" been vacant or is this a new building? Yes E -of, <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E N" A <br />6. Location of the business and suite numberJEklstfloor tr 2ndfloorr\ <br />7. Do you share the floor or business entrance with another business? Yes tr No H <br />8. What is the amount of square footage leased?4 'D <br />9. How much of the space, which you lease, is office? <br />F.1O0o/o n soo/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 I <br />Less than 30% <br />_ floor <br />tr