CHANGE OF ADDRESS City of Cupertino
• 10300 Torre Avenue
CITY OF Cupertino,CA 95014-3255
Telephone: (408)777-3228
CU P E IST I N O FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: November 10, 2004
RE: Address Change (APN #316-25-039)
• Please note the following address change: 20311 Stevens Creek Blvd #1 has been
divided into two suites. The new suite numbers are 20311 Stevens Creek Blvd. Suite #
1A and 1B. Please change your records accordingly.
The new address will take effect immediately. If you have any questions, please call
me at (408) 777-3246.
Sincerely, - l
Susan Winslow
Administrative clerk
Printed on Recycled Paper
CITY OF CUPERTINO
.ge 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 27551 PRINT DATE 10/26/2004
PRINT TIME 14 : 00 : 41
RECEIPT DATE 10/26/2004 OPERATOR counter
COPY # 4
RECEIVED BY counter CASH DRAWER: BS1
REC ' D. FROM MING ZHONG
USER 1
USER 2
NOTES : CHANGE OF ADDRESS 20311 ST CRK #lA/1B
FEE ID AMOUNT THIS RCPT BALANCE
ZADDCHG 268 . 00 268 . 00 0 . 00
TOTALS : 268 . 00 268 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
(QC-K-
. 'CK -- - - - - ----- ------
-268- - -. -00- 827---- - -- ----
TOTAL RECEIPT 268 . 00
•
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- ( \ City of Cupertino
00 To
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Telephone: (408)777-3228
Fax: (408)777-3333
•
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print):
TELEPH NE NUMBER: 4y 2i 11 ? 101 Z
CPa
PNP � 3fb
EXISTING ADDRESS: ao 31 ( S Z/e-%-S C4-R-P—JG RM S
NEW ADDRESS REQUESTED: 0- AeVeK5 A oszk OVA .SIL $# I FF
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) a
The fee for a change of address r"equest is��268.00. he 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 lie in effect thirty (30) days following approval.
Signature Date
•
Revised 10/16/02
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