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-,-SANTA <br />AI,[A,'liilffi <br />) <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) 647-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this completd form with your Certificate of Occupancy application. <br />Company Name (Print) <br />contactName: 3tVV€ LAVI@ <br />Address (business mailing address): +-|qO lZVltJ= E'LVD , qt € PE. ZL? <br />City:lz-t/lt'E State: Cl. zip: 4%?D <br />4reEL@-?gA,blZPhone No., %b'1 14-1 6+L E-mail Address <br />E Cnange of Property Owner I Cnrng" of Occupant ! Change of Use E ndditional Occupant <br />1. The following best describes my operation: <br />K Ofice Only E Retail Sales n Medical/Dental <br />! Warehouse/Manufacturing/Distribution fl Restaurant/Take Out Food <br />ff 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 pubtic). CopEULfArJf OiltL_ l=t JLrF{'=ff. | ;VarrAy <br />3 <br />S: Planning\Clerical-Counter Forms\ <br />CofO Questionnane 08-27 -18 <br />9. How much of the space, which you lease, is office? <br />K rcov" n 5oo/o tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />(Please contact the leasing agent or building <br />o%e' e_ <br />What was the former type of business or use of facility?i <br />owner to determine prior business use.) - VpYggDN / <br />/ <br />4. Has the building or space been vacant or is this a new building? yes K No n <br />lf vacant, for how long? UAr(+fOtl..)I-l <br />5. Are you an independent contractor? Yes E ruo E <br />6. Location of the business and suite number: <br />Kt"noo,. B2"oftoo, !_ftoor <br />7. Do you share the floor or business entrance with another business? Yes E ruo K. <br />8. What is the amount of square footage leased? <br />Less than 30%