102-Application for Alcoholic Beverage License.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: 505662
100 PASEO DE SAN ANTONIO Receipt Number: 2028056
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: November 4, 2010
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE
First Owner: PAIZ 2 INC
Name of Business: rb6HT WINC-t-F000
Location of Business: 20333 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2225
County: SANTA CLARA
Is Premise inside city limits? Yes Census Tract 5081.01
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 Type Master Dup Date Fee
41 - On -Sale Beer And Wine ANNUAL FEE NA Y 0 11/04/10 $350.00
41 - On -Sale Beer And Wine ORIGINAL FEES NA Y 0 11/04/10 $300.00
Total $650.00
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: November 4, 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)
.PAIZ 2 INC See 211 Signature Page
State of California
APPLICATION SIGNATURE SHEET ("SIGN N")
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. Partnership Corporation
• All signatures must be notarized in accordance Married Couple RLimited Liability Company
with laws of the State where signed.
Domestic Partner DOther
41 ®Original Person to Person Transfer
Exchange Premise to Premise Transfer
1-1 Other
P*2- ?-, /lye-
6. APPLICANT'S MAILING ADDRESS (Street address/P.O. box, city, state, zip code)
a®333 SIFee^4^ 61ycel< 11lvd , C�gs dy
7. PREMISES ADDRESS (Street address, city, zip code)
AO 3 3 3 S fie,.-75 Crrel< r3lc��, Cu m- . C� id v is
APPLICANT'S CERTIFICATION
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) He/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 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
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 fail to qualify for the license or withdraw
this application there will be a service charge of one-fourth of the
license fee paid, up to $100.
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
KI
M
CORPORATION
10, PRINTED NAME (Last, first, middle) SIGNATURE
Ivan Mozara X
TITLE
*President Vice President Chairman of the Board
PRINTED NAME (Last, first, middle) SIGNA
Frank Ashton X 9/
Secretary �Asst. Secretary Chief Financial Officer nAsst. Treasurer
LIMITED LIABILITY COMPANY
l�l�Q�vls�
/r/�e//o
11, The limited liability company is member -run 11 Yes DNo (If no, complete Item #12 below)
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
first,
r
illV110
ABC-211-SIG (2/09) "SIGN ON"