102-Department of Alcoholic Beverage Control Application.pdfDepartment of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 2
TO: Department of Alcoholic Beverage Control File Number: 502546
100 PASEO DE SAN ANTONIO Receipt Number: 2013144
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: August 16, 2010
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE
First Owner: ALFREDOS PASTA INC
Name of Business: FLORENTINES
Location of Business: 10275 SIDE ANZA BLVD
CUPERTINO, CA 95014
County: SANTA CLARA
Is Premise inside city limits? Yes Census Tract 5077.01
Mailing Address:
(If different from
premises address)
Type of license(s): 41
Transferor's license/name: 422474 PHOENIX THREE Dropping Partner: Yes No
RESTAURANTS INC
License Tvpe Fee Transaction DateType Fee Type Master Du Qj
NA STATE FINGERPRINTS NA N 4 08/16/10 $156.00
NA FEDERAL FINGERPRINTS NA N 4 08/16/10 $96.00
41 - On -Sale Beer And Wine PERSON -TO -PERSON TRANSFER NA y 0 08/16/10 $150.00
41 - On -Sale Beer And Wine ANNUAL FEE NA y 0 08/16/10 $350.00
NA ISSUE TEMPORARY PERMIT NA y 0 08/16/10 $100.00
Total $852.00
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? Yes
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 premises 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: August 16, 2010
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is ail 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 iij.dc; (4) traiisfer
application or proposed transfer is not made to satisfy the payment of 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 oftransferor; (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)
ALFREDOS PASTA INC See 211 Signature Page
State oi California
APPLICATION SIGNATURE SHEET ("SIGN ON"'
* This form is to be used as the signature page for
applications not signed in the District Office.
* Read instructions on reverse before completing.
* All signatures must be notarized in accordance
with laws of the State where signed.
E]Sole Owner
ElPartnership
Ell-lusband & Wife
Partnership -Ltd
[�Corporation
01-imited Liability Company
FlOther
2. FILE NUMBER (If any) 3. LICEN61: I Yl't Ii. 1"NbAI,11UJN [Tra
[:]Original �erson to Person Transfer
ElExchange OPremise to Premise Transfer
[]Other
5. APPI WANIT(S) NAME (Last, first, middle)
C-
6. APPLICANTS MAILING ADDRESS (Street address/P.O. box, city, state, zip code)
7. PREMISESADDRESS—(Street addr city, zip code)
APPLICANT'S CERTIFICATION I
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.
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
_DATE
0:P'R_1NTED NAME (Last, first, middle)
SXIG NAT U
SIGNED
TITLE
President Vice President F] Chairman of the Board
Secretary �Asst. Secretary D Chief Financial Officer []Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member -run Yes No (If no, complete Item #12 below)
-1-2—.-NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
am
NAME (Last,
ABC-21 1 -SIG (2/03)