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102-Alcoholic Beverage License Application.pdfDepartment of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSES) ABC 211 (6/99) TO: Department of Alcoholic Beverage Control File Number: 504087 100 PASEO DE SAN ANTONIO Receipt Number: 2020620 ROOM 119 Geographical Code: 4303 SAN JOSE, CA 95113 Copies Mailed Date: September 28, 2010 (408) 277-1200 Issued Date: DISTRICT SERVING LOCATION: SAN JOSE First Owner: IPOT CUPERTINO LLC Name of Business: LITTLE SHEEP MONGOLIAN HOT POT Location of Business: 19062 STEVENS CREEK BLVD CUPERTINO, CA 95014-2522 County: SANTA CLARA Is Premise inside city limits? Yes Census Tract 5080.02 Mailing Address: (If different from premises address) Type of license(s): 41 Transferor's license/name: Dropping Partner: Yes No License Type Transaction Type Fee ape Master Dup Date Fee NA STATE FINGERPRINTS NA N 3 09/28/10 $117.00 NA FEDERAL FINGERPRINTS NA N 3 09/28/10 $72.00 41 - On -Sale Beer And Wine ORIGINAL FEES NA Y 0 09/28/10 $300.00 41 - On -Sale Beer And Wine ANNUAL FEE NA Y 0 09/28/10 $350.00 Total $839,00 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? 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 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: September 28, 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 Sipdcure(s) .IPOT CUPERTINO LLC