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08. Alcoholic beverage licenses-CITY OF OFFICE OF THE CITY MANAGER CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 7ELEPNONE: (408) 7r7-3212 • FAX: (408) 777.-3366 CUPERTINO SUMl~ZARY AGENDA ITEM NUMBER ~~- AGENDA DATE ~' 3~J ~~~ p SUBJECT AND ISSUE Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Pebbles Deli Cafe Location: 10235 Sout~ De Anza Boulevard Type of Business: Restaurant Type of License: On Sale Be~:r &Wine-Eating Place (41) Reason for Application: Original & .Annual Fees, State & Federal Fingerprints RECOMMENDATION There are no use permit restrictions or zoning restrictions which would prohibit this use and staff has no objection to the issuance of the license. Prepared by: ao, City Planner Submitted by: ~~ David W. Knapp, City Manager G:planning/mist/abc Pebbles Deli Cafe 8A - 1 Department of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHpLIC BEVERAGE LICENSE(S~ ABC 211 (6/99) TO: Department of Alcoholic Beverage Control File Number: 483498 100 Paseo de San Antonio Receipt Number: 1735744 Rm. 119 Geographical Code: 4303 San Jose, CA 9511.3 Copies Mailed Date: October 8, 2009 (408)277-1200 Issued Date: DISTRICT SERVING LOCATION: A E First Owner: Name of Business: Location of Business ISM JOSEPH JUNGSUP PEBBLES DELI CAFE 10235 S DE ANZA BLVD CUPERTINO, CA 95014-3007 County: SANTA CLARA Is premise inside city limits? .Yes Census Tract .5080.01 Mailing Address: {If different from premises address) Type of license{s): 41 J Transferor's license /name: / Dropping Partner: Yes No ~/ License Tvne Transaction TvDe Fee Typg Master wig. A~~ F~.~ , .:: 41 ON-SALE BEER AND ORIGINAL FEES NA Y 0 10/ 0 8 /0 9 $300.00 41 ON-SALE BEER AND ANNUAL FEE NA Y Q ' `I O / 0 8 / 0 9 `.: $ 339.00 4i ON-SACS BEER AND STATE FINGERPRINTS NA N ~ ` ` 2 10 / 0 8 / 0 9 $78.00 41 ON-SALE BEER AND FEDERAL FiNGQtPR[NTS NA ~ ~ .;N 2 ~ 10 / 0 $ / 0 9 $48.00 .. .. Total $765.00 Have you ever been convicted of a felony? N o Have yt?u ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? No Explain any 'Yes" answer to the above questions on an attachment which shall be deemed pazt of this application. Applicant agrees (a) that any manager employed in an on-sale licensed premise will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. _ STATE ~OF CALIFORNIA County of SANTA CLARA Date: Octolser 8, 2009 Under penalty of perjury, each person whose signature appears below, certlftes and says: (1) He is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that he has read the foregoing and knows the contents thereof and that each of the above statements therein made are true; (3) that no person other than the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; (4) that the transfer application or proposed transfer is not made to satisfy [he payment of a loan or to .fulfill an agreement entered .into -more than ninety (90} days preceding the .day on which the transfer application is filed with the Department or to gain or establish .a preference to. or for any creditor or transferor or to defraud or injure any creditor of transferor; (.5) `that the transfer applicator may be withdrawn' by either 'the applicant or the licensee with no resulting liability to the Department. .. Apphcarif Name(s) . ~ ~ Applicant `Signature(s) ... KIM JOSEPH JUNGSUP ' 4ee 211 Signatnrp Pagp KIM YOUNG OK ~ - 8A-2 State of Cal'I`omia APPLICATION SIGNATURE SHEET ("SIGN ON') Department of Alcoholic Beverage Control - -- - ._ _ . • This form is to be used as the signature page for applications not signed in the District Office. ; ^Sole Owner Partnership-Ltd Read instructions on reverse before completing. a Partnership Corporation • All signatures must be notarized in accordance a Married Couple ~ Limited Liability Company wifh Jaws of the State where signed. ~ ~DomesticPartner Other 2. F-ILt NUMI3tti (Ir anyl 3. UGENSE l YPE ~4. TRANSAG I ION 1 YPt .'Original ~Persan to Person Transfer Exchange ~ Premise to Premise Transfer 41 i Other (Lest, arst, miuale) Kim, Young, Ok Kim, Joseph Jungsup &. APPLICANTS MAN.ING ADDRESS (Street addressfP.O. box, aty, state, zip tale) 10235 S. De Anza Blvd., Cupertino, CA 95014 7. PREMISES ADDRESS (S1ree1 address, city, zip code) 10235 S. De Anza Blvd., Cupertino, CA 95014 APPLICANT'S CERT7FICATJON Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He/She is an applicant, or one of the applicants, or an executive officer rifthe applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that he/she Itas read the foregoing and knows the contents thereof and that each of the above statements therein made are true; (3) that no person othel• than the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; {4} that the transfer payment of a loan or to fulfill an agreement entered into more than ninety (90) days preceding the day on which the transfer tpplication is filed with the Department, {b) to gain or establish a preference to or for any creditor or transferor, or (c) to defraud or injure any creditor or transferor; (5}that The transfer application tnay be withdrawn by either the applicant or the licensee with no resuliing ]iabiliq~ to the Department. I understand that if I fail to qualify for the license or withdraw this application there will be a service charge ofone-fourth of the license fee paid, up to $104. 50LE OWNER 8. PRINTED NAME (Leal, first, X PARTNERSHIP/LIMITED PARTNERSHIP {Signatures of general partners only) Kim, Young Ok Kim, Joseph Jungsup 1 X ,~ f' ~ ' G gip, (SIGNATURE ~' ~ DATE S G ED 'X CORPORATION 10. PRINTED NAME (Last, first, middle) {SIGNATURE DATE SIGNED iX President ~Vice President [Chairman of the Board 'X ~] Secretary ~Assf. Secretary Chief f=inancial Officer Asst. "treasurer LIMITED LIABILITY COMPANY 11. The limited liability company is member-run ~~Yes ~No (If no, complete Item #12 below) 12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle) . v. mesa) X MEMBER'S PRINTED NAME (Last, first, X 8A-3 ABC-211-SIG (2/09) "SIGN ON" Notary Acknowledgement State of ~~ County of .S'Q-n~f ~ c%~~ On S a • ~-~~ before me, /~aw~cl'~- ~~ ,Notary Public, personally appeared ~,oi,~n '`h-- ,who proved to me an the basis of satisfactory evi ence to be the person( whose name(s.~~a~ subscribed to the with'sn instrument and acknowledged to me that~.e/she-i executed the same in his/her/their authorized capacity}, and that by -}her/tl~signatures on the instrument the person(-}, or the entity upon behalf of which their 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 official seal. ~J~/ - NOTAR SIGNATURE NOTARY IMPRESSION HERE ~~~ DAVfD BYUNGOH KIM Gommisslon ~ 1840841 ~ Notary Public - Callfornla Santa Glara Gounty -• Gomm. Ex 'rea Mar 16, 2013 Notary Acknowledgement State of ' - ~~.- County of S~n~~- G~~i-~- On SPA- 30 • ~-°~'~ before me, ~~%~-~~ N~ ,Notary Public personally appeared ,, o " ~~- /~~~'~- ~+~'^- ,who proved to me on the basis of satisfactory evidence to be`~ie persons}-whose name{} is/~ subscribed to the within instrument and acknowledged to me that he/~/ executed tfie same in his/i~F/tl authorized capacity(i~}, and that by his/-~r/ti~etr-signatures on the instrument the person-, or the entity upon behalf of which their person(~}~acted, executed the instrument. T 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 official seal. NOTAR SIGNATURE NOTARY IMPRESSION HERE OAVID BYt1NGOH KIM Commission #~ 1840641 -rti' Notary Public - CalllarMa Santa Clara County Comm. Ex Tres Mar 16, 201 a - 4 G1TY OF OFFICE OF THE CITY MANAGER CITY HALL 10300 TORRE AVENUE= • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3212 • FAX: (408) 777-33G6 CUPERTINO SUM1V[ARY AGENDA ITEM NUMBER ~~ SUBJECT AND ISSUC Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application RECOMMENDATION AGENDA DATE~a~ ~.~~ Gokaku 10789 South Blaney Avenue Restaurant On Sale Beer &Wine-Eating Place (41) Person-to-P+:rson Transfer, Annual Fee, State & Federal Fingerprints There are no use permit restrictions or zoning res~xictions which would prohibit this. use and staff has no objection to the issuance of the license. Prepared by: :~ ~ i , C ry Chao, City Planner G:planning/misc/abc Gokaku Subrnitted by: /~~ David W. Knapp, City Manager 8B-1 Department of AIcoholic Beverage Control APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) AaC 211 (6/99) TO: Department of Alcoholic Beverage Control 100 Paseo de San Antonio Rm. 119 San Jose, CA 95113 (408)277-1200 DISTRICT SERVING LOCATION: SAN JOSE First Owner: Name of Business: Location of Business: County: Is premise inside city limits? Mailing Address: (If different from premises address) Type of Iicense{s): 41 GOKAKU LLC GOKAKU State of California File Number: 484249 Receipt Number: 1739650 Geographical Code: 4303 Copies Mailed Date: November 4, 2009 Issued Date: 10789 S BLANEY AVE CUPERTINO, CA 95014-4500 SANTA CLARA Yes 34908 LIMESTONE CT UNION CITY, CA 94587 Census Tract 5080.01 Transferor's Iicense/name: 471697 / Y00 HYUNSOOK Dropping Partner: Yes No License Type Transaction Tyke Fee e Iylaster ~u~ Date Fee 41 ON-SALE BEER AND PERSON TO PERSON TRANSF NA Y 0 1 I / 0 4/ 0 9 $150.00 41 ON-SALE BEER AND ANNUAL FEE NA Y 0 11/04/09 $339.00 41 ON-SALE BEER AND STATE FINGERPRINTS NA N 2 1 110 4 / 0 9 $78.00 41 ON-SALE BEER AND FEDERAL FINGERPRINTS NA N 3 1 1 / 0 4 / 0 9 $72.00 Total $639.00 Have you ever been convicted of a felony? N o Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? No Explain any "Yes" answer to the above questions on an attachment which shall be deetned part of this application. Applicant agrees (a) that any manager employed in an on-sale licensed premise will have ail the qualifications of a licensee, and (b} that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. STATE OF CALIFORNIA County of SANTA CLARA Date: November 4, 2009 Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duty authorized to make this application on its behalf; (2) that he has read the foregoing and knows the contente thereof and that each of the above statements therein [Wade are true; (3) that no person other. than the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the license(s) for _ whit![ this application is made; (4) that the transfer application or proposed transfer is not made to satisfy [he payment of a loan or to fulRll an agreement entered into more than ninety {90) days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any crulitor or transferor or to defraud or injure nay creditor of transferor; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the DeparGnent. Applicant Name(s) Applicant Signature(s) GOKAKtJ LLC ~ ~U,W 8 -2 CITY OF. CUPERTINO City Hall 10300 Torre Avenue Cupertino, CA 95014 (408} 777-3212 Fax: (408) 777-33b6 OFFICE OF THE CITY MANAGER SUMN[ARY AGENDA ITEM NUMBER ~C SUBJECT AND ISSUE. Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application: RECOMMENDATION AGENDA DATE 1'~ ~ ~• a ~~ Z~ ~ 7 Eleven 21490 McClellan Road Market Off Sale Beer & Wine (20} Person-to-Person Transfer, Annual Fee, State & Federal Fi1~.gerprinting, and Duplicate Fee There are no use permit restrictions or zoning; restrictions which would prohibit this use and staff has no objection to the issuance of i:he license. License Type 20 authorizes the sale of beer and wine for consumption off thE~ premises where sold. Prepared by: a o, City Planner G:plnnr~irrg/rrrisr,/a6c7-1 T Submitted by: David W. Knapp, City Manager 8C-1 Department of Alcoholic Beverage Control APPLICATION FOR ALCOI30LIC BEVERAGE LICENSE{S) ADC 2t 1 (6/99) State of California TO: Department of Alcoholic Beverage Control ]00 Paseo de San Antonio Rrn. l19 San Jose, CA 95113 (408)277-1200 DISTRICT SERVING LOCATION: SAN .IOSE First Owner: Name of Business: Location of Business: County: Is premise inside city limits? Mailing Address: (If different from premises address) File Number: 484432 Receipt Number: 1740438 Geographical Code: 4303 Copies Mailed Date: November 10, 2009 Issued Date: 7 ELEVEN INC 7 ELEVEN 2367 25717D 21490 MCCLELLAN RD CUPERTINO, CA 15014-4052 SANTA CLARA Yes PO BOX 2245 BREA, CA 92822-2245 Census Tract 5077.01 Type of license(s): 20 Transferor's license/name: 460471 / 7 ELEVEN INC Dropping Partner: Yes No License Tvve Transaction Txpe Fee e Master Dun Date ~ 20 OFF-SALE BEER ANI PERSON TO PERSON TRANSF NA Y 0 1 1 / 10/0 9 $50.00 20 OFF-SALE BEER ANI ANNUAL FEE NA Y 0 1 1 / 1 0/09 $246.00 30 TEMPORARY PERMr DUPLICATE NA Y 1 1 1/ 1 0/ 0 9 $100.00 20 OFF-SALE BEER ANI STATE FINGERPR]NTS NA N 4 . 1 1 / 10/ 0 9 $156.00 20 OFF-SALE BEER ANI FEDERAL FINGERPRINTS NA N 4 1 1 / 1 0/ 09 $96.00 Total $648.00 Have you ever been convicted of a felony? N o Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? N o Explain any "Yes" answer to the above questions on an attachment which shall be deemed part of this application. Applicant agrees (a) that any manager employed in an on-sale licensed premise will have al l the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage _Control Act. STATE OF CALIFORNIA County of SANTA CLARA Date: November 10, 2009 Under penalty of perjury, each person whose signature appears below, certifies and says; (1) He is an appficanl, or one of the applicants, or an executive officer of the applicant corporation, named in the Foregoing application, duly authorized to make this application on its behalf; (2) Thal he has read the foregoing and knows the contents thereof and that each of the above stalemeats therein made arc titre; (9) that no person other than the applicant or applicants has any direct or lndirecl interest in the appiicam or applicant's business to be conducted under the license{s) for which this application is made; (4) that the. transfer application or proposed transfer is not made to satisfy the payment of a loan or to hrlfill an agreement entered into more than ninety (40) days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or injure auy creditor of transferor; {S) that the uarrsfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. Applicant Name(s) Applicant Signature(s) 7 ELEVEN INC ~ t1 ,4ignatnrr pa.gP DUKAAN DOH WC ~^ I I ac-2 Slate of California APPLICATION SIGNATURE SHEET ("SIGN ON') Department of Alcoholic Beverage Confrol • This form is to be used as the signature page for .,.,,'~„~"~- ~ ~ r~ `~ pw w~~~ applications not signed in the District office, ^Sole CMmer Partnership-Ltd • Read fnsfYUCflor)s on reverse before comp/efing. ©Partnership ~Corparation • All slgnafures must be notarized !n accordance ~~Married Couple ULimifed L~abilliy Company with laws of the Sfafe where sfgned C~Domestic Partner ~Olher ~. ,.,"..,..,,.".,,,W,,, ... ~,.,"...~.,... -.. ,,.._.v9....,...._ ~Ori inrd ~X Person to Person Transfer 20 Exchange Premise io Premise Transfer ~Olher 5. APPLICANT{S) NAME (Last first, rMddle) 7-Eleven, Inc, and DUKAAN DOH INC. 6. APPLICANT'S MAILING ADDRESS (Street addresslP.O. box, Cllr, aisle, zip code) P.O. Box 2245, Brea CA 92822-2245 7. PREMISES ADDRESS (Street address, dly, zip wde) 21490 McClellan Road, Cupertino CA 45014-4052 APPi.lCANT'S CERTIFICATION Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He/Slze is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) [hat he/she has read the foregoing and knows the contents thereof and first each of the above statements therein made are tree; (3) that no person other than the applicant or applicants has any direct or indirect interest in the applicant or applicants business to be conducted under the Iicense(s} for which this application is made; (4) that the transfer SOLE OWNER PARTNERSHIPlL1MITED PARTNERSHIP (Signatures of general partners only) Huey, David George I X~~!!~/ ±~% ~~ Z. TITLE President ®Vice President ~Chalrman of the board PRINTED NAME (Last, rxst mkkYe) SIGNATURE ~ DATE SIGNED Varela, Antonio Enrique Xc__--~~ C~s~'4~ ((~ ~Z(~ Z~(~L/ TITLE , ^Secretary ~X Assl. Secretary Chief Financial Officer ~Assl. Treasurer LIMITEb LIABILITY COMPANY t 1, The limited liability company is member-run ~"es ~No (If no, complete Item #12 below) 12 f4AME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last fxst mlddli~) payment of a loan or to fulfill an agreement entered into more than ninety (90) days preceding the day on which the transfer application is filed with the Department, (b) to gain or establish a prr:ference to or for any creditor or transferor, or (c) to defraud or injure any creditor or transferor; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. I understand that if T fail to qualify for the license or withdraw thi;> application there will be a service charge of one-fourth of the license fee paid, up to $100, CORPORATION 7-Eleven, Inc. ABC-217-SIG (Z/09) "SIGN ON" SIGNATURE ACKNOWLEDGEMENT I+'OR ABC DOCUMENTS ABC-211-SIG ("SIGN-ON") A4ARI{1;T/STOR)C # 7-Eleven Store 2367-25717D ADDRESS 21490 McClellan Road Cupertino CA 95014-4052 APPLICANT (S): 7-Elcven, Inc. Ritu Singh ,President and and DUKAAN DOH INC. Atatajit Singh Dhsnoa, Vice Pr sident and Secretary State of California } } ss. County of Alameda } On this the -~CV-f~~ day of ~. lC~~ ~~ ~t~L~ ~ ,before me, Susan Curry Flores Notary Public, the undersigned personally appeared, David George Huey Typed Name who proved to me on the basis of satisfactory evidence to be the person(p~ whose name() is/a-t e subscribed to the within instrument and acknowledged to me that he/~Ye/th~y executed the same in his/her/tlret'r authorized capacity(i~, and that by his/her/tjterr signature( on the instrument the person{,v}, or the entity upon behalf of which the person(j~ 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 official seal. / ') ~L _ ~fU n.cQ,~~ C~t Notary's Signature Seal w -> Description of Attached Document Title or Type of Document: ABC-211-SIG ("SIGN-ON") Capacity Claimed by Signer Signer's Name: David George Huey D Individual ~ Corporate Qflicer -Title: Vice President Signer is Representing: 7-ELEVEN INC + 1 SUSAN CURRY FlORES COMM. #1823399 Notary PuWiaCalflomia AIAtdEDA COUNTY Niy CarKn. Exp, DEC 77, 2072 8C-4 SIGNATURE ACKNOWLEDGEII~IENT FOR ABC DOCUMENTS ABC-211-SiG ("SIGN-ON") MARKETISTORE N ADDRESS 7-Eleven Store 2367-25717D 21490 McClellan Road Cupertino CA 95014-4052 APPLICANT (S): 7-L~leven, Inc. Ritu Singh, President and and DUKAAN DOH INC. Atamjit Singh Dhanoa, Vice President and Secretary State of California } } ss. County of Alameda } On this the °~~t day of :1 , _~~+ before me, Susan Curry Flores Antonio Enrique Varela Typed Name Notary Public, the undersigned personally appeared, who proved to me on the basis of satisfactory evidence to be the person whose name( is/~ subscribed to the within instrument and acknowledged to me that he/~/try executed the same in his/b~.ek/th~if authorized capacity i~.~j, and that by his.R~e'Y/t~r signature~aj oa the instrument the person'}, or the entity upon behalf of which the pers~~n(~ 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 official seal. ,,,,. SUSAN Cl7RitY FLORES .- COMM. #1823399 rn ih s Notary Publlo~CalMomla N ~ ALAMEDA CDUN?Y '' My Canon. Exp. DEC 17, 2012 U S e,,~ ~ U S Notary's Signature Se:tl Description of Attached Document Title or Type of Document; ABC-211-SIG ("SIGN-ON") Capacit3~ Claimed by Signer Signer's Name: Antonio Enrique Varela_ ^ Individual ~ Corporate Officer-Title: Assistant Secretary Signer is Representing: 7-ELEVEN INC 8C-5 Slate of California APPLICATION SIGNATURE SHEET ("SIGN ON"} Department of Alcoholic Beverage Control • This form is to be used as tha signature page for ~Soie Owner applications not signed in the District Office. • Read fnstrucfions on reverse before compfeffng. ~x Partnershlp • Aff sfgnafures must be notarfzed fn accordance Married Couple wffh laws of the Slate where sfgned. Domestic Partner Partnership-Ltd ~Corporatlon Limited Liability Company Other 2. F{LE NVMlittt 1~r anyt ~. ~.....,..._ ... - .. ~Orlginal x Person to Person Transfer Exchange Premise to Premise Transfer 2U Other 7-fileven, Inc. and DUKAAN DOH INC. 6. APPUCANPS MAILING ADDRESS (SVeel eddresalP.O. bax, dly, stale, zip code) P.O. Box 2245, Brea CA 92822-2245 7. PREMISES ADDRESS (Street address, dly, zip code) 2I490 McClellan Road, Cupertino CA 95014-4052 APPLICANT'S CERTiF~ca ~ rvro Under penalty of perjury, each person whose signature appears below, certifies and says: (1) I3e/She is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf, {2) that he/she has read the foregoing and knows the contents thereof and that each of the above staternertts therein made are true; (3) that no person other than the applicant or applicants has any director indirect interest in the applicant or applicant's business to be conducted under the lirensefsl for which this application is made; {4) that the transfer payment of a loan or to fulfill an agreement entered into more than ninety (90} days preceding the day on which the transfer application is.filed with the Department, (b) to gain or establish a preference to or for any creditor or transferor, or (c } to defraud or injure any creditor or transferor; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. I understand that if I fait to gaalify for the license or withdraw this application there wilt be a service charge ofone-fourth of the license fee paid, up fo 5100. 50LE OWNER D~oT~i~ccutan IMITFI~ P~RTNFRSHIP (Signatures Of deneral.PartnerS Only) Singh, Ritu ~Presldent Vice President Chairman of the Baard Dhanoa, Atatnjit Singh l C:1r~(o ~ ~`~ t" ~ nSecretary ~Assi. Secretary Chief 1=lnancial Officer ~AssL Treasurer LIMITED LIABILITY COMPANY 11. The limned liability company is member-run Yes ~No (If no, complete Item #12 below) 12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (last, fKS4 middle) ire/2 (a CORPORATION DUKAAN DOH INC. „•,.~ ~,,,~,~„ 8C-6 ABC-211-SiG (2109) "SIGN ON" SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS ABC-211-SIG (":+IGN-ON") MARKET/STORE # 7-Eleven Store 23b7-25717D ADDRESS 21490 McClellan Road Cupertino CA 95014-4052 APPLICANT (S): 7-Eleven, Inc. Ritu Singh, President and and DUKAAN DOH INC. Atamjit Singh Dhanoa, Vice President and Secretary State of California } } ss. County of Alameda } On this the ~ (d`~-~ day of ~ .. .~ `~ ~ ,before me, Susan Curry Flores ,Notary Public, th~~ undersigned personalty appeared, Atamjit Singh Dhanoa Typed Name who proved to me on the basis of satisfactory evidence to be the person( whose name(,v) is/~a'i: subscribed to the within instrument and acknowledged to me that he/ske/tjq`ey executed the same in his/ly~r/tlt~ir authorized capacity{~~), and that by his/la~r/tl~ir signature) on the instrument the person(), or the entity upon behalf of which the person{~) 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 niy hand and offici eal. ~ SUSAN CURRY FLORES .- COMM. #1$23399 to in NoSary Publlo-CaUfon,la y W ALAMEDA COUNTY '' My Comm. Exp. pEC i7, 20i2 _ - ,. ~, Notary's Signature~ ~ Sea[ Description of Attached Document Title or Type of Document: ABC-211-SIG ("SIGN-ON") Capacity Claimed by Signer Signer's Name: Atamjit Singh Dhanoa ^ Individual . © Corporate Officer-Title: Vice President and Secretary Signer is Representing: DUKAAN DOH INC. 8C-7 SIGNATURE ACKNOWLEDGEMENT FOR AliC DOCUMENTS ABC-211-SIG ("SIGN-ON") MARL{ET/STORi; ~ ADARESS 7-Eleven Store 2367-25717D 21490 McClellaa Road Cupertino CA 95014-4052 APPLICANT (S): 7-Eleven, Inc. Ritu Singh, President anti and DUKAAN DOH INC. Atamiit Singh Dhanoa, Vice President and Secretary State of California } } ss. County of Alameda } On this the ~ ~,~~_ day of ~~ Q~ , .~, before me, Susan Curry Flores Notary Public, the undersigned personally appeared, Ritu Singh Typed Name who proved to me on the basis of satisfactory evidence to be the person{~d) whose name(~j is/~e subscribed to the within instrument and acltnowledged to me that /she/tp~y executed the same in h~5/her/t ~r authorized capacity(i~, and that by,~s/her/t~hei~ signa#ure~ on the instrument the person , or the entity upon behalf of which the person() acted, executed the instrument. I certify under PENALTY OF PERNRY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offic' eel. SUSAN CURRY FLORES .= ~~ COMM. #1823399 N N Notary PuWb.Califomfa W AtAMEDA COIAVTY ~ ~ ~ comet ~,. aEC ~~, zolz ~r Notary's Signature Seal Description of Attached Document Title or Type of Document: ABC-2II-SIG ("SIGN-ON") Capacity Claimed by Signer Signer's Name: Ritu Singh ^ Individual © Corporate Officer -Title: President Signer is Representing: DUKAAN DOA INC. 8C-8 OFFICE OF THE CITY MANAGER CITY HALL 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3212 • FAX: (408) 777-3366 SUMMARY AGENDA ITEM NUMBER ~_ SUBJECT AND ISSUE Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application: RECOMMENDATION AGENDA DATE ~! ~ 3 ;~ as q Bonjour Crf;pe Company 19929 Stevf;ns Creek Boulevard Restaurant On Sale Beer &Wine-Eating Place (41) Original & ,annual Fees, State & Federal Fingerprints There are no use permit restrictions or zoning restrictions which would prohibit this use and staff has no abjection to the issuance of the license. Prepared by: ciao, ity Planner G:planning/misc/abc Bonjour Crepe Submitted by: S David W. Knapp, City Manager 8D-1 Department of Alcoholic Beverage Control APPLICATION. FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 2i1 (6/99) File Number: 483633 Receipt. Number: 1'1364G6 Geographical Code: 4303 Copies Mailed Date: October 14, 2009 Issued Date: TO: Department of Alcoholic Beverage Control 100 Paseo de San Antonio Rm. 119 San Jose, CA 95113 (408}277-1200 DISTRICT SERVING LOCATION: ,SAN JOSE First Owner: Name of Business: Location of Business: County: Is premise inside city limits? Mailing Address: (If different from premises address) Type of license(s): 41 Transferor's license/name: ABHYANKER RAJ VASANT BONJOUR CREPE COMPANY 19929 STEVENS CREEK BLVD CUPERTINO, CA 95014-23GG SANTA CLARA Yes State of California Census Tract 5081.01 Dropping Partner: Yes No License TvAe Transaction TXpe ee T a t r Duo Date Fee 4I ON-SALE BEER AND OR(GINALFEES NA Y _ 0 10/14/09 $300.00 41 ON-SALE BEER AND ANNUALFP.,E NA Y 0 10/14/09 $339.00 41 ON-SALE BEER AND STATEF[NGERPRINTS NA N 1 10/14/09 $39.00 41 ON-SALE BEER AND FEDERALF[NGERPRIN'fS NA N I 10/ 14/09 $24.00 Total $702.00 Have you ever been convicted of a felony? N o Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? No Explain any "Yes" answer to the above questions on an attachment which shall be deemed part of this application. Applicant agrees (a) that any manager employed in an on-sale licensed premise will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. STATE OF CALIFORNIA County of SANTA CLARA Date: October 14, 2009 Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that he has read the foregoing and knows the contents thereof and that each of the above statements therein made are tnie; (3) that no person other than the applicant or applicants has any direct or indirect' interest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; (4) that the h'ansfer application or proposed transfer is not made to satisfy the payment of a loan or to &~Ifill an agreement entered into more than ninety (90)'days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor; (S) that [he tramfer application may be withdrawn by either the applicant or the licensee with no resulting [lability to the Department. Applicant Name(s) Ap~icant Signature(s) ABHYANKER RAJ VASANT 8D-2