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Planning and Building Agency <br />Planning Divislon <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, C492702 <br />(71416/.7-5804 <br />www.santa€na.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please tum in <br />Company Name (Print) <br />this completd form with your Certificate of Occupancy application. <br />. Smiths lnterconnect Americas lnc <br />Richard JohannesContact Name: <br />Address (business mailing address)1231 E. Dyer Road Suite 235 <br />City:Santa Ana state, CA zip'92705-5665 <br />Phone No.978-760 -5447 E-mailAddress:richard.johannes@smithsinterconnect.com <br />f] Change of Property Owner E Change of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />I Omce Only ! Retailsales E Medicat/Dental <br />E Warehouse/Manufacturing/Distribution E RestauranUTake Out Food <br />E Ottrer (describe) <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 />open to the public)' <br />sales, Marketing and Engineering support open from 6:00 am until <br />6:00 pm <br />3. What was the former type of business or use of facility2 (Please contact the leasing agent or building <br />owner to determine pnor bustness use.) <br />Sales Office <br />4. Has the building or space been vacant or is this a new building? Yes El No E <br />lf vacant, for how long?6 month <br />5. Are you an independent contractor? Yes E No E <br />6. Location of the business an d suite number: 1231 E. Dyer Santa Ana Suite 235 <br />tr lstfloor E 2ndfloor ! _floor <br />7. Do you share the floor or business entrance with another business? Yes E ruo E <br />8. What is the amount of square footage leased?31 85 <br />9. How much of the space, which you lease, is office? <br />E looo/o tr 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 />tr Less than 30% <br />,-,,SAI{TA <br />ANA/riili*