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Plannlng and Bulldlng Agency <br />Plannlng Dlvlrlon <br />20 Clvlc Centsr Phze <br />P.O. Box 1988 (M.20) <br />Srnta Anr, CA 02702 <br />(714) 647.5104 <br />tvlffUt .!antr{ns.otg <br />Please tum in thls compteted form wtth <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Company Name (print):AltaMed Health Services Corporatio n <br />contacr 1,1"r" Genevieve Lloyd <br />Address (business mailing address):2040 Camfietd Avenue <br />City:Los Angeles <br />state, CA <br />Phone No.: 323-559-7666 <br />E-mail Address:glloyd <br />your Certiftcate of Occupancy appltcatlon. <br />90040 <br />@altamed.org <br />Q Change of Property Owner E Change of Occupsnt ffi Crrange of Use E Additional Occupant <br />1. The following bort dsscrlbar my operatlon; <br />I Offtce Onty fiJ Retalt Satee E MedtcattOcntat <br />E warchouee/Manufacturing/Drrtrrbuaon ! Restauranurake out Food! Otner (descrtbe) <br />lf vacant, for how long? <br />5 Are you an independent contractor? yes fl No E <br />6. Location of the busineea and euite number: <br />E ldfloor D 2nrfloor ! <br />-ttoor <br />2. prease provido a brief description of how the bueinese operates at this erte (ror examprs, preaeedegcribe the general nature of the ousinesi, what acriviriel ;ccii illi; the houra of operatton,open to the publlc)' <br />This wiil be a pharmacy: gpgn Monday-Friday gam - 7pm, saturday9am - 1pm, and Sunday is closed. ' --' <br />3' m*;?lH:;:H:l?#i*Xg:ss or u'o or racititv? (ptease contac*he /eas,ns asent orburctins <br />Medical <br />4. Has tho building or space bean vacant or is thrs a new building? yes D No il <br />7 Do you share the froor or business entrance wirh anorrer busineee? yes E No E <br />8. What is the amount of square footage lgaged? fh! bu'ttog tr 6mod by AtrMn, H..tth E.fric.r Co|Eorlm <br />9. How much of the space, which you lease, is office? <br />tr looo/o ;1 so% tr 30% <br />lf other than 100%, how is the remaining space used? <br />space is not leased <br />B Lese than 30% <br />S: A!nningtChm!Counlcr Fotrnr\ <br />ColO Clurluonn.im O&ZZ-t I <br />.,N'ISANIA <br />ANArlilir