CHANGE OF ADDRESS Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
CUPERTINO
TELEPHONE: (408)777-3228 • FAX: (408)777-7606
OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: February 1, 2011
RE: New/Change of Address APN #362-09-002
Please note the following address change: 1196 Elmsford Dr is adding an attached 2nd
unit. The main house will remain 1196 Elmsford Dr and the 2nd unit will be 1196 Elmsford
Dr. Unit 1. See 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,
.'xLx1 i
Susan Winslow
Administrative Clerk
Ci?y of Cupertto
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http://gissvr/cupertinointranet/home/mapFile.aspx Tuesday, February 01, 2011 4:05 PM
Building Department -9 1
CITY OF CUPERTINO 1
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
TELEPHONE:(408)777-3228 • FAX: (408)777-3333 Gl'
CUPERTINO
CHANGE OF ADDRESS/ADD SUITE NUMBERS
REQUEST FORM
NAME (please print): CHEN, N S IN M i d a4 TAN , FE I S A
TELEPHONE NUMBER: 40 S 0 6 0299
APN (assessor's parcel #): _3 6 a — 05 - 002- 60
EXISTING ADDRESS: I Ob ELMSFORD DIS. CUPSRI NO , C6HQIL-}
NEW ADDRESS REQUESTED: I i q �t m5ol�h IL -
NEW SUITE NUMBERS REQUESTED: Z
Request for address change will be approved only if the change meets the following criteria:
1. The change of address will not create confusion.
2. Only the LAST DIGIT will be considered.
3. The odd/even addressing system will be maintained.
4. Suite numbers must be NUMERIC.
5. The change of address will not result in a public safety hazard.
6. A reduced-scale copy (81/2 x 11 or 11 x17) of a site plan which shows addresses on each side of
the building site,along with the closest address across the street from the entrance of the
building. If there are unit or suite numbers,show the layout of the units and have all
unit/suite numbers on the site plan. _
7. PROOF OF OWNERSHIP IS REQUIRED. (property tax bill)
The fee for a change of address/addition of suite numbers request is$317.00 (per hour). The fee is
due with this request form and will not be refunded if the request is denied.
The direct costs associated with an address change/addition of suite numbers request will be
borne by the applicant. Approximate review time is fifteen (15) days. If the address change is
granted, the new address will be in effect thirty (30) days following approval.
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12/15/2010 8:56 AM
' • CITY OF CUPERTINO •
RECEIPT NUMBER: BS000012335
RECEIVED BY: PAYOR: DAVID PERNG
TODAY' S DATE: 12/21/10 REGISTER DATE: 12/21/10
TIME: 15:58
1
ADDRESS CHANGE ADDR 10211/10215 ALHAMBR $317 .00
----------------
TOTAL DUE: $317 .00
CREDIT CARD: $317 . 00 REF NUM: VISA
TENDERED CHANGE
$317. 00 $ .00
CITY OF CUPERTINO
ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: suety
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36209002.00,
DATE ISSUED. . . . . . . : 12/21/2010
RECEIPT #. . . . . . . . . : BS000012334
REFERENCE ID # . . . : 10120074
SITE ADDRESS . . . . . : 1196 ELMSFORD DR
SUBDIVISION . . . . . . .
CITY . . . :. . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ED CHEN
ADDRESS . . . . . . . . . . : 1196 ELMSFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HSINMIN CHEN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
lADDINSP SQUARE FEET 480.00 258.00 0.00 0.00 258 . 00
1ADDPLCK SQ FEET 480 .00 1438 .00 1438 .00 0 .00 0 . 00
1ADDRESS HOUR 1 . 00 317. 00 0 . 00 317 . 00 0. 00
1BCBSC VALUATION 60, 000 . 00 3 . 00 0 . 00 0 . 00 3 . 00
1BCONSTAXR FLAT RATE 1 . 00 558 .42 0 . 00 0 . 00 558.42
1BSEISMICR VALUATION 60;000 . 00 6. 00 0 . 00 0 . 00 6.00
1PLLONGR SQUARE FEET 480 . 00 62 .40 0 . 00 0 . 00 62 .40
1R3PLNCK SQUARE FEET 480 . 00 911. 00 911 . 00 0 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 3553 . 82 2349.00 317 . 00 887 .82
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 317. 00 #ADDRESS CHANGE
---------------
TOTAL RECEIPT 317. 00
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