BLD-2020-02112 Request for Permit ExtensionCITY OF
CUPERTINO
VEST FOR PERMIT EXTENSION
REQ
Please e-mail the completed form to
[]✓ Under Plan Review Process
Building Address:
Owner Name: Beck
Owner Address:
11420 Charsan LN Cud
and Revital
1420 Charsan LN
permitcenter@cupertino. org
CA 95014
✓❑ Issued Permit
Permit Number: BLD-2020-02112
CA 95014 Phone: 408-873-1434
Contact Name: Mordechay Beck
E-mail Address: MottiBeck@gmail.com Phone: 408-219-9786
Reasons) (please be specific): Misunderstanding of the
signature: � �� � Date:8�25/2023
(CITY OF CUPERTINO USE ONLY)
Yes No
Approval: ❑ ❑ Expired Date:
Fee: $
ae��a ��25/2oi�