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Please turn in this completed form with your Ceftificate of Occupancy application. <br />Company Name (Print):Accutech Dental Studio <br />contact Name: HYung Ju Kim <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 />(7141il7-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCGUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Address (business mailing address):1702 Newport Circle Unit O <br />City:Santa Ana state, CA zip 92705 <br />phoneruo., 714-668-0433 E_maitAddress: info@accutechds.com <br />E Change of Property Owner E Change of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />! Ofice Only ! Retailsales n Medical/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)' office and light industrial manufacturing of dental prosthetics. <br />3. What was the former type of business or use of facility2 (Please contact the leasing agent or building <br />owner to determine prior business use.) <br />Office Space. <br />4. Has the building or space been vacant or is this a new building? Yes ! No E <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes f] No E <br />6. Location of the business and suite numbe r' 1702 Newport Circle unit O <br />E 1'tfloor tr 2ndfloor E _floor <br />7. Do you share the floor or business entrance with another business? Yes E No E <br />8. What is the amount of square footage leased?600 <br />9. How much of the space, which you lease, is office? <br />tr looo/o tr sooh tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />Dental Laboratory <br />En Less than 30% <br />S:Planning\Clerical-Counter Forms\ <br />Cofo Questionnaire 08-27-18 <br />,,,-SAI,{TA <br />ANAqilffi