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NO PERMIT NUMBER (6) 1 0 aN City of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 CITY OF Telephone: (408)777-3228 CU P E I,T I NO FAX: (408)777-3333 BUILDING DEPARTMENT OFFICIAL NOTIFICATION OF NEW ADDRESS ASSIGNMENT TO: All Agencies FROM: City of Cupertino DATE: February 08, 2008 • RE: Address assignment Please note the following address assignment. Parcel 375-35-016.5825 Bollinger Rd is adding a new residence. The existing address 5825 Bollinger Rd (Lutheran Church of our Saviour) will stay the-same. The new address for the residence will be 10785 Carver Drive, Cupertino CA. 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 1 1 � � ` 1 1 Alk r !ca m M ELM � • .moi � � E �. r. : • s �3 �� - • - a'j 5 �` ':�; " l� nv��— "' lit ��1 r -^•1 ° '^ q� ` I X835 r� .� ta., ��N W� w� a ^ � u'^i (� ' � . + ( �' -_H2_. • (q3 ' •�.,' ti's► a�0� 1 (� X0600 f " fiat'a Zp0j .�. .,. 1.006 � '}' •,,,,., tFlgp ZO � 1 . ,f. /900 /9010 19,10 40 /9010 /9080 , 5 I 62.14 19,60 p 1 c `1W 52 ' I I I 55 4/ 105.34^ `n 146 wry^h V 50 51 II 52 II 53 III 54 1� 131 ^q o°1po 56 132 u3.13 6 6 I 127 �1 l28 1 129 1 l30 14569 _ -... 113367.65 32 I II ... yb.92 15 65 I 9 N 1 7 1 8 h 1 3,30 AC. GR. 6 I 37 IS 36 I� NI 3.02 AC30. NET I- ml / 38 i — 1 ��� 35 -I � 60 6 32.3s /yam I h 39P1 J9l C Q 3999 PLACE 3909 �F .o J90 ,69590.2o IF I W 2'O 59 B 3914 �N 34 10 rt I 60 1Ill3 ?.23 345 1\ MI u 16 31 11� 32 Ilo 33 S06' I 1 13 1" 12 h 11 1 ! NEWSOM N18980 /8970 8 60 /B9 /B9/O 60.20 65 130 29 �' '6'j 1 r 1 --� r---r so— { 1 51.01 sl.ol 1 si 15 .01 I cool I -41.0 I 1 I I I� 3 24 I 25 I 26 27 1 I 1 11 Im 10 iM 9 i N 15h 14 m 13 I� 121m — la — h o "1 I 1 20 j 1918 �^ 17 '128: �'- 1- "'' 147 I 148 i 149 i 150 i 151 i 152 i 153 1 I 1 1 I 2c9.si u 51 I 51 51 5s 60 1 51 1 55 66.96 25 I1 60 907 60JBB9 60 sees T RACT N° 1287 3JB1! SB55 4 ROA 0 a BOOK c 3Lo 77 o a p� or DIU • Community Development Department City of Cupertino 10300 Torte Avenue . Telephone: (408) 777-3228 `Fax: (408)777-3333 NEW ADDRESS ASSIGNMENT FORM DATE: l _ 2/9"- O p NAME (please print): L v �iU C fl Ul'Cy ©C` TELEPHONE NUMBER: "� �' Z S_Z — a3 APN: 3S=oi NEW ADDRESS: /0C/�2t/f • 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 refunded 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 CITY OF CUPERTINO 71d Oa /C/ . RECEIPT NUMBER: BS000003795� RECEIVED BY: SUEW PAYOR: LUTHERAN CHURCH TODAY' S DATE: 01/29/08 REGISTER DATE: 01/29/08 TIME: 10 :33 1 ADDRESS CHANGE NEW ADDR 10785 CARVER DR $306 . 00 ---------------- TOTAL DUE: $306 . 00 CHECK $306 . 00 REF NUM: 1005 TENDERED CHANGE $306 . 00 $ . 00 • • Aimessoes Accounts 06058040014 Connrmadonx 1913697573 Submission Date: 111412008 10:35:52 AM ® BUSINESS TO: LAWRENCE E.STONE PROPERTY ASSESSOR OF BY APRIL 1,2006 . STATEMENT C 95 SANTA CA COUNTY 70 W.HEDGING ST.,SAN JOSE,CA 95110-1771,PHONE(408)299-5400 MAKE NECESSARRY CORRECTIONS OF THE PRINTED NAME AND MAILING ADDRESS DECLARATION OF COSTS AND OTHER RELATED PROPERTY • (File a separate statement for each location) INFORMATION AS OF 12:01 A.M.,JANUARY 1,2006 LOCATION OF THE BUSINESS PROPERTY 375-35-016 AS 091 060660-0001-6 N AREA L NAME AND MAILING ADDRESS RETURN THIS ORIGINAL FORM.COPIES WILL NOT BE ACCEPTED LUTHERAN CHURCH OF OUR SAVIOUR THE CONTACT NAME: HAS BORELMAN 5825 BOLLINGER RD, CUPERTINO CA 95014 CONTACT PHONE: (408) 257-9860 PART I: GENERAL INFORMATION L. Enter najpdp6aber of authorized personal contact at location of accounting COMPLETE(a)THRU(g) RELIGIOUS records: 257-9850 a. Enter type of business: g. During be period of January 1,2007 through December 31,2007: D. Enter local telephone number( 4CI8 252-0345 FAXnumber( ) 11) Has all or pan of this real property been subject to a Mange in ownership? E-Mail Adorns(aplional) ❑Yes IS No C. Do you own the land at this business location? R Yes ❑ No (2) Are any related enides conducting business in the county? ❑Yes ® No If yes,Is the name on your deed recorded as shown on this statement? Is Yes ❑ Ne If yes,provide name,mailing address,and locations: d. When did you said business at this location? DATE: 10/1/1955 If your business name or location has changed from last year,enter the former name and/or (3) If you leased this real property,has it been the subject of a lease agreement for a period location: of 35 years or more(including options)? ❑ Yes ® No (4) Did you acquae'conirol'through acquisition of stock or otherwise of a legal entity which e. Enter location of general ledger and all related accounting records(Include zip code): owns real property In this aunty? ❑Yes 19 No (5) Dd another person or entity acquire"control"through acquisition of stock or otherwise of this corporation or entity? ❑Yes 2 No PART II: DECLARATION OF PROPERTY BELONGING TO YOU (OGGUST N Cents) attach schedule/or any adjustment to cost see instructions ASSESSOR'S USE ONLY • 1. Supplies 3,000 2. Equipment (From line 35) 23.0,671 3. Equipment out on lease,rent or conditional ale to others (Affach Schedule) 4, Blill Bdg.Impc,anclor Leasehold lmpc,Land lmpr.,Land (From line 71) 92,063 5. Construction In Progress (Attach Schedule) C Allemata Schedule A (See Instructions) 7. B. PART III: DECLARATION OF PROPERTY BELONGING TO OTHERS-IF NONE WRITE"NONE" Report conditional sales contracts that am not leases on Schedule A ISPECIFY TYPE BY CODE NUMBER) Description 1. Leased equipment 4. Vending equipment Year Year and Lease Cost d Annual 2. Lease-purchase option equipment 5. Other businesses Aa, Of Identification or Purchase Rent 3. Capitalized leased equipment 6. Gowemmentrownetl property Number Tax Obligation: A.Lessor B.Lessee 9. Lessors name NONE Malin address 10. Lessors name Mailing address OWNERSHIP TYPE(1) DECLARATION By ASSESSEE Proprietorship ❑ NOTE:The following declaration must be completed and signed. III do not do so,It may result In penalties. 1 declare urderpena9y ofper)ury under the laws of the Stale of California that I have examined this property statement.including accompanying schedules,statements brother attachmerns, Partnership ❑ and to the best of my knowledge and belief d is true,correct,and complete and includes all property required to be reported which is owned,claimed,possessed,controlled,or managed by Corporation 21 the person named as(be Assesses in this statement at 12.01 a.m.on January 1,2008. Other ❑ SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT' DATE Ly BUSINESS NAME OF ASSESSEE OR AUTHORIZED AGENT'pywd or printed) TIRE DESCRIPTION(-I Retail ❑ NAME OF LEGAL ENTITY(other than DSI(ryped orpdnted) FEDERAL EMPLOYER ID NUMBER Wholesale ❑ 94-1434630 Manufacturer ❑ PREPARERS NAME AND ADDRESS(typed or printed) TELEPHONE NUMBER TITLE SmAcefProfessional ® I ( ) 'Agent: See S3B for Declaration by Assesses Instructions THIS STATEMENT SUBJECT TO AUDIT BOE-571-L(S1 F)RvA31947) INFORMATION PROVIDED ON A PROPERTY STATEMENT MAY BE SHARED WITH THE STATE BOARD OF EOUILIZATION