Address Change aV
City of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
CITY Of Telephone: (408)777-3228
TUPEkTINO FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF NEW ADDRESS ASSIGNMENT
TO: All Agencies
FROM: City of Cupertino
DATE: January 13, 2009
RE: Address assignment- APN#357-14-026
• Please note the following address assignment. 21871 Dolores Ave is being divided into
two lots. Lot 1 will be 21881 Dolores Ave, and lot 2 will remain 21871 Dolores Ave.
Please update your records accordingly. See the attached map.
The new address will take effect 30 days from the date of this letter. if you have any
questions, please call me at (408) 777-3246.
Sincerely,
Susan Winslow
Administrative clerk
Printed on Recycled Paper
01/12/2009 09:57 FAX 408 777 3333 0002/0002
Comtmmtty DevcWpm=d Depa t==
City of Cupcitino
10300 Tose Av==
• Telephone: (408)777-3228
Fax: (408)777-3333
NEW ADDRESS
ASSIGNMENT FORM
DATE:
NAME(please print): TSO u H S k
TELEPHONE NUMBER 409 — 4- (, L[ ti-D O x —6? 2
APN: lu - D2(o �S��c�iVS;�� Z °fis �C2e(°an�ea2
NEWADDRESS: Z l8 9, l Do lores
The new address will be assigned using the following criteria:
1. The new address will not create confusion.
2. The Odd/even addressing system will be maintained.
3. The new address will not result in a public safety hazard
4. PROOF OF OWNERSHIP IS REQUIRED. (Ex.property tax bill)
The fee for processing a new address request is $306.00 (per hour). The fee is due
with this request form-and will not be refimded if the request is denied.
The direct costs associated with a new address request will be borne by the
applicant. Approximate review time is fifteen (15) days. If the address is granted,
the new address will be in effect thirty(30) days following approval.
Signature
•
Revised 10/16/02
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•
City of Cupertino
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http://gissvr/cupertinoassessor/home/mapFile.aspx Monday, January 12, 2009 9:02 AM
CITY OF CUPERTINO
RECEIPT NUMBER: BS000006954
RECEIVED BY: PATRICIAG PAYOR: TRACY HSU
TODAY' S DATE: 01/13/09 REGISTER DATE: 01/13/09
TIME: 08 : 58
1
ADDRESS CHANGE 1. 000 @ $306 . 00 $306. 00
----------------
TOTAL DUE: $306 . 00
CREDIT CARD: $306 . 00 REF NUM: visa
TENDERED CHANGE
• $306 . 00 $ . 00
•