Certificate Questionnaire Form – Fill Out and Use This PDF

Please turn in this completed form with your Certificate of Occupancy application.

Company Name (Print):

Contact Name:

Address (business mailing address):
City:				State:			Zip:
Phone No.:				Fax No.:

1.What was the previous use of the space you wish to lease? (Please contact the leasing agent

or building owner to determine prior business use.)

2.	Has the building or space been vacant or is this a new building? Yes			No
	If vacant, for how long? ___________________________________
3.	Are you the primary tenant? Yes	No
4.	Do you sublease from an existing tenant? Yes		No
5.	Are you an independent contractor?	Yes	No

6.Location of the business and suite number: ___________________________________

	1st floor	2nd floor	___ floor
7.	Do you share the floor or business entrance with another business? Yes			No

8.What is the amount of square footage leased? _________________________________

9.How much of the space, which you lease, is office?

100%

50%

30%

Less than 30%

If other than 100%, how is the remaining space used?

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10.Please provide a brief description of how the business operates at this site (for example, please describe the general nature of the business, what activities occur on-site, the hours of operation, open to the public).

If yes, what will be the dimensions?

If yes, please describe:

If yes, please describe:

14.Do you plan on making any improvements to the building such as: exterior painting,

signage, interior tenant improvements? Yes

No

If yes, please describe:

Does the proposed use involve a patient care profession, such as doctor, dentist,

chiropractor, acupuncturist, or physical therapist? Yes

No

15.Is the proposed use within the mental health profession, such as:

If yes, please describe:

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18.Will your business be offering massages as part of your business operation? This includes massage as ancillary to pedicures, manicures, and other services.

Yes No

22.Does your business service or repair vehicles or install equipment and accessories into

vehicles? Yes No

If yes, please explain:

I DECLARE UNDER PENALTY OF PERJURY, THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Signature

Date

Print Name

Title

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Information

The Planning Division’s Public Counter is open for walk-up customers from 8:00 a.m. to 4:00 p.m., Monday through Friday, except Wednesday 10:00 a.m. to 4:00 p.m. The Planning Division is located within City Hall – Ross Annex, 20 Civic Center Plaza, First Floor. Additionally, you may call us at (714) 647-5804 should you require any general information.

The Planning Division reviews Certificate of Occupancy requests for change of address, new businesses, or expansions to ensure that the proposed use is consistent with the established zoning regulations of Santa Ana. Please check with the Planning Division’s Public Counter prior to signing a lease or committing your business to a certain location to determine the feasibility.

If a nonconforming use is discontinued, or if a nonconforming building is vacant, unused or unoccupied for a period of 12 consecutive months, any subsequent use must conform in every respect to the provisions of the Municipal Zoning Code, and a nonconforming building may not thereafter be used or occupied until it conforms in every respect to the provisions of the Code.

Generally, the following uses will require further documentation or an extended review and may or may not be permitted: office uses within an industrial zone; medical, restaurant, laundromat, trade or technical schools, and automotive repair and service uses within spaces that were not previously used for such purposes; a building that does not meet the parking demand for the proposed use; or a use which generates a higher parking demand or adherence to development standards than the previous uses.

You may need to provide floor plans, site plans, or document the prior use before obtaining a Certificate of Occupancy to determine the grandparented rights of a nonconforming use, or a use which has additional Code requirements.

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