CHANGE OF ADDRESS Building Department
CITY OF CUPERTINO
CUPERTINO 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
TELEPHONE:(408)777-3228 • FAX: (408)777-3333
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: November 10, 2010
RE: Address Change APN#326-55-026
Please note the following address change: 21164 Hazelbrook Dr, Cupertino is being changed to
21168 Hazelbrook Dr., Cupertino. Please update your records accordingly. 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,
Susan Winslow
Administrative Clerk
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Oct 25 2010 12: 29PM CITY OF CUPERTINO 408 .777 7606 P• 1
Building Department artment NOV 4 2010 D
CITY OF CUPERTINO I
10300 TORRE AVENUE • CUPERTA(O,CA 95014 ffiw�
TELEPHONE:(408)7773228 • FAX: (408)777.3333
CUPERTINO
CHANGE OF ADDRESS/ADD SUr NUMBERS
REQUEST FORM I
NAME(please print); A mDRG W 7 (/0A1\l
TELEPHONE NUMBER: C��tpJ SQ 1 - �/
APN (assessor's parcel#): // -3 - OZ�
EXISTS: �ING ADDRESS: /1 P 44 Hct?e I b roz)k D ri of , t pa t t.n Cf} ?so/5L
NEW ADDRESS REQUESTED: D- ( 16 o rl a ze I b rug k Ib r!u e,0er ;fd CA 9S0/V
NEW SUITE NUMBERS REQUESTED:
Request for address change`will be approved only If the change meets the following criteria:
1. The change of address will not create'confusioi-L
i
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(8 Y2 x 11 or 11 x17) of a site plan which shows addresses on each side of
the building site,along with the closest address acmes the stzeet 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 93317,00 (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 requestwill 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.
Signature Date
r
CITY OF CUPERTINO
RECEIPT NUMBER: BS000011940
RECEIVED BY: SUEW PAYOR: ANDREW T WAN
TODAY'S DATE: 11/08/10 REGISTER DATE: 11/08/10
TIME: 13 : 52
1
ADDRESS CHANGE 21164 TO 21168 HAZELBROOK $317 . 00
----------------
TOTAL DUE: $317 . 00
CHECK $317 . 00 REF NUM: 1010
TENDERED CHANGE
$317. 00 $ .00
RECORDING REQUESTED BY:
Chicago Title Company DOCUMENT: 20923678 Pagest 2
Escrow No.: 30.98420086
Locate No.: CACr3774}774}2994.0098420086 Fees. . 18.00
Title No., 10-98420086-RP 1111111111111111111 Taxes . . 1442 65
When Recorded Malt Document Cop i as.
.
and Tax Statement To: AMT, PAID 1460.65
Mr. and Mrs. Andrew T, Wan
21164 Hazelbrook Drive REGINA ALCOMENDRAS RDE a 011
Cupertino,CA 95014 SANTA CLARA COUNTY RECORDER 10/22/2010
Recorded at the request of 8:00 AM
Chicago Title
APN: 326-55-026 SPACE ABOVE THIS UNE FOR RECORDERS USE
GRANT DEED
The undersigned grantor(s)declare(s)
Documentary transfer tax is$1,442.65
Judi (, BOisstcat/Declarant
[ X I computed on full value of property conveyed, or
[ computed on full value less value of liens or encumbranc emaining at time of sale,
[ Unincorporated Area City of Cupertino,
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Judith K. Bolssicat, surviving
joint tenant
hereby GRANT(S)to Andr w T, kV�n and Vicky Wan, husband and wife as community property with Right of
sun vote
the following described tea propeWy in the City of Cupertino, County of Santa Clara, State of California:
SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF
DATED: October 13, 2010
State of California ) — 0
County of Santa Clara Judith,{ , oissicat
On before me,
+A Zgw -0Notary Public
'here Insert name and title of the officer), personally appeared MICHAEL H. YEE
Ii3dith K. Boissicat. U COMM.♦ 1840305
Yho proved to me on the basis of satisfactory evidence to be the Q ROTARY PutuC•CALIFORNIA 0
ierson(s)whose name(s)is/are sub abed to the within instrument SANTA CLARA COUNTY 0
n2d knowledged to me that he /they executed the me in COY9.FMOiRfS MARCH 13 2013
hi h their authorized capacity ), and that by his/ a/their
signature(s) on the Instrument the person(s), or the en upon
behalf of which the person(s)acted,-executed the Instrument:` -- — -
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph Is true and correct.
WITNESS my hand and tial seal.
Signature — (Seal)
MAIL Ter STATEMENTS AS DIRECTED ABOVE
FD-213(Rev 12/07) GRANT DEED
(grantsc)(0609)
Escrow No.: 10.98420086 I ,
Locate No.: CACn774717743.2984.0096420086
Title Noa 10-9842008&RP
t
EXHIBIT "A°
THE LAND REFERRED TO HEREIN BELOW IS SITUATED IN THE CITY OF CUPERTINO, COUNTY OF SANTA CLARA,
STATE OF CALIFORNIA AND IS DESCRIBED AS FOLLOWS:
All of Lot 140, 'Tract No. 682 Garden Gate Village Unit No. 2", which Map was filed for record on February 20, 1950 in
Book 26 of Maps, pages 24 and 25, Santa Clara County Records.
APN: 326-55-026