102-Department of Alcoholic Beverage Control Application.pdfDepartment of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
TO:Department of Alcoholic Beverage Control File Number: 502046
100 PASEO DE SAN ANTONIO Receipt Number: 2011236
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: August 3, 2010
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN .POSE
First Owner: SMOKE EATERS CUPERTINO L-PSHIP
Name of Business: SMOKE EATER HOT WINGS
Location of Business:
County:
Is Premise inside city limits?
Mailing Address:
different from
premises address)
V.1111 JIM 81
Census Tract 5080.01
Type of license(s): 41 4
Transferor's license/name: Dropping Partner: Yes NoX
LicenseTe Transaction Type
41 - On -Sale Beer And Wine ORIGINAL FEES
41 - On -Sale Beer And Wine ANNUAL FEE
Fee T Me
Master
Du
2
Date
_
NA
y
0
08/03/10
NA
y
0
08/03/10
Total
Have you ever been convicted of a felony? No
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.
Fee
$300.00
$350.00
$650.00
Applicant agrees (a) that any manager employed in an on -sale licensed premises will have all the qualifications of
a licensee, and (b) that he will not violate or cause or pen -nit to be violated any of the provisions of the Alcoholic
Beverage Control Act.
STATE OF CALIFORNIA County of SANTA CLARA Date: August 3,2010
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 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 the 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 application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department,
Applicant Name(s) Applicant Signature(s)
.SMOKE EATERS CUPERTINO L-PSFHP See 211 Signature Page
State of California Department of Alcoholic Beverage Control
APPLICATION SIGNATURE SHEET ("SIGN ")
t.OWNERSIAIP TYPE (Check one)
This form is to be used as the signature page for
applications not signed in the District Office. Sole Owner Partnership -Ltd
m Read instructions on reverse before completing. [ Partnership EMICorporation
• All signatures must be notarized in accordance Married Couple Limited Liability Company
with laws of the State where signed.
Domestic Partner Other —
L. PILL NUMbtK (it any) 3. LlUtML I YVL N. IKAIVbAUI IUN I YYL
nOriginal Person to Person Transfer
ElExchange 0 Premise to Premise Transfer
41
Other
Smoke Eaters Cupertino, L.P
6. APPLICANT'S MAILING ADDRESS (Street address/P.O. box, city, state, zip code)
45 Hance Road, Fair Haven, New Jersey 07704 AUG 2 2010
7. PREMISES ADDRESS (Street address, city, zip code)
10650 S. De Anza Blvd., Cupertino, California 95014
APPLICANT'S CERTIFICATION
Under penalty of perjury, each person whose signature appears
payment of a loan or to fulfill an agreement entered into more than
below, certifies and says: (1) He/She is an applicant, or one of
ninety (90) days preceding the day on which the transfer
the applicants, or an executive officer of the applicant
application is filed with the Department, (b) to gain or establish a
corporation, named in the foregoing application, duly authorized
preference to or for any creditor or transferor, or (c ) to defraud or
to make this application on its behalf, (2) that he/she has read the
injure any creditor or transferor; (5) that the transfer application
foregoing and knows the contents thereof and that each of the
may be withdrawn by either the applicant or the licensee with no
above statements therein made are true; (3) that no person other
resulting liability to the Department.
than the applicant or applicants has any direct or indirect interest
I understand that if I fail to qualify for the license or withdraw
in the applicant or applicant's business to be conducted under the
this application there will be a service charge of one-fourth of the
license(s) for which this application is made; (4) that the transfer
_
license fee paid, up to $100.
SOLE OWNER
8. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures
of general partners only)
9. PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
CORPORATION
90. PRINTED NAME (last, first, middle)
Sir IATUREE
DATE SIGNED
Borneo, Michael C.
07/30/10
IIILjPresident Vice President Chairman of the Board
PRINTED NAME (Last, first, middle) S DATE SIGNED
Borneo, Marcel R. X 07/30/10
TITLE._
Secretary Asst. Secretary L�Chief Financial Officer Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member -run Yes No ( no, co e e Item II12 below)
-- --- -- - - ----- - .._.._...__... - - - - --- - - �y -
72. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
13. MEMBER'S PRINTED NAME (Last, first, middle)
WL
ABC-211-SIG (2/09)
X
"SIGN ON"
1MAR(AVIGNOLA
NOTARY PUBLIC
STATE OF NEW JERSEY
MY COMMISSION EXPIRES JULY -1, 2014
LON 21 980