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CffiOISANTA <br />AltA/riltffi <br />Plannlng and Building Agency <br />Plannlng Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, C492702 <br />(714) 647-s804 <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 />(r\Lnt):Company Name <br />Contact Name: <br />City: <br />^"tAddress (business mailing address):] <br />State: <br />Fax No. <br />cm\cntr-frm\C of O qu€stionnaire <br />0712012 <br />What was the previous use of the space you wish to lease? (Ptease contact the teasing agent <br />or building owner to determine prior business use.) <br />4v^.r^^-b e &a [.r^rcJ, d-*\* <br />Has the building or space been vacant or is this a new building? Yes ! *o K <br />zip: <br />t <br />1 <br />2 <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />lf vacant, for how long? <br />Are you the primary tenant? v", S No E <br />Do you sublease from an existing tenant? Yes E ruo K <br />Are you an independent contractor? Yes E No E <br />Location of the business and suite number: <br />St" Roor tr 2nd floor ! <br />- <br />floor <br />Do you share the floor or business entrance with another business? Yes E No E <br />What is the amount of square footage leased? <br />How much of the space, which you lease, is office? <br />tr looo/o tr so% n 30% <br />lf other than 100%, how is the remaining space used? <br />Page 1 of4 <br />F Less than 30% <br />\^-\,,^*b--^,< <br />+ <br />PhoneN".''l \\ ai-92- N3 z ? <br />(A