CHANGE OF ADDRESSCUPEkTINO
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
FAX: (408) 777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: July 07, 2004
• RE: Address Change (APN #342-16-034)
Please note the following address change: 10660 Santa Lucia Road is changing its
address to 10668 Santa Lucia Road. Please change your records accordingly.
The new address will take effect thirty 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
Community Development Department
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print): BEE- C400 y PNCr
TELEPHONE NUMBER: 402,
APN: X42 —I -0o
EXISTING ADDRESS: 10 (o CoO JU n t—o. LU C- Ga, FO a 4
NEW ADDRESS REQUESTED: 1 0 6 (os 3 61 a t a �—U ct a RoG d
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. The change of address will not result in a public safety hazard.
5. PROOF OF OWNERSHIP IS REQUIRED. (Ex. property tax bill)
The fee for a change of address request is $268.00. 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 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.
"JJ04 A 1104
Signature 1.3 Date
Revised 10/16/02
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CITY OF CUPERTINO
PP e 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # : 26174
RECEIPT DATE : 07/01/2004
PRINT DATE : 07/01/2004
PRINT TIME : 14:00:46
OPERATOR : counter
COPY # : 3
RECEIVED BY counter CASH DRAWER: BS1
RECD. FROM BEE CHOO YANG
USER 1
USER 2
NOTES : CHG ADDRESS FROM 10660 SANTA LUCIA RD. TO 10668 SANTA LUCIA
FEE ID AMOUNT THIS RCPT BALANCE
ZADDCHG 268.00 268.00 0.00
-------- -------- --------
TOTALS: 268.00 268.00 0.00
fOD OF PAYMENT AMOUNT NUMBER
------------- --- ------
OTHER 268.00 M/C
TOTAL RECEIPT 268.00
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