07. ABC License
CITY OF
CUPEIQ"INO
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER ,
AGENDA DATE September 5, 2006
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
Merlion Marketplace, Inc.
19628 Stevens Creek Boulevard (Marketplace)
Restaurant
On-Sale General for Bona Fide Public Eating Place (47)
Person-to-Person Transfer and Annual Fee
RECOMMENDATION
There are no use permit restrictions or zoning restrictions which would prohibit this use and staff
has no objection to the issuance ofthe license.
Prepared by:
Ci~it~~
Submitted by:
~
David W. Knapp, City Manager
G: IPlanninglMISCELL IABClabc albertsons.doc
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Printed on Recycled Paper
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
AIlC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Room 119
San Jose, CA 95113
(408) 277-1200
DISTRICT SERVING LOCATION:
Control
File Number: 443844
Receipt Number: 1578825
Geographical Code: 4303
Copies Mailed Date: August 25, 2006
Issued Date:
Fi rst Owner:
Name of Business:
SAN .lOSE
MERLION MARKETPLACE INC
MERLION MARKETPLACE INC
Location of Business:
19628 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2465
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Yes
Census Tract 5080.01
Type of license(s): 47
Transferor's license/name:
74734
/ HAMASUSHI INC Dropping Partner:
Yes
No
License Type Transaction Type Fee Type Master Dup Date
47 ON-SALE GENERAL I PERSON TO PERSON TRANSF P40 Y 0 08/25/06
47 ON-SALE GENERAL I ANNUAL FEE P40 Y 0 08/25/06
47 ON-SALE GENERAL I PREMISE TO PREMISE TRANS P40 Y 0 08/25/06
Total
Fee
$1,250,00
$758.00
$100,00
$2,108,00
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 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: August 25, 2006
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 orncer 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) thai the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
ugreement entered into more than ninely (90) days preceding the duy on which the transfer upplication is riled with the Depurtment or to gain or
establish a preference to or for uny creditor or transferor or to defwud or injure uny creditor of transferor; (5) thut the transfer applicution may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department,
Applicant Name(s)
Applicant Signature(s)
MERLION MARKETPLACE INe
See 211 Signature Par;e
1-2.
State of California
APPLICATION SIGNATURE SHEET ("SIGN ON")
I 1 OWNERSHIP TYPE (Check one)
I
. 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.
2, FILE NUMBER (II any)
3 LICENSE TYPE
47
5 APPLlCANT(S) NAME (Last, Itrst, middle)
Merlion Marketplace, lnc,
Department of Alcoholic Beverage Control
D Sole Owner
o Partnership
D Husband & Wife
D Partnership-Ltd
o Corporation
D Limited Liability Company
D Other
4. TRANSACTION TYPE
D Original
D Exchange
EJ Person to Person Transfer
EJ Premise to Premise Transfer
D Other
6. APPLICANT'S MAILING ADDRESS (Slreet addresslP.O box, cily, stale, Zip code)
19628 Stevens Creek Blvd" Cupertino, CA 95014
7. PREMtSES ADDRESS (Slreet address, City, zip code)
Same as above
APPLICANT'S CERT/FICA T/ON
Under penalty of pel jury, each person whose signature appears
below, certifies and says: (I) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing aPRlication, 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
application or proposed transfer is not made to (a) satisfy the
payment of a loan or 10 fulfill an agreement entered into more than
ninety (90) days preceding thc 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
II1jure 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,
SOLE OWNER
8 PRINTEO NAME (Last, firsl, middle)
I SIGNATURE
IX
I DATE SIGNED
I
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNER'S PRINTEO NAME (Last. flrsl, middle) I SIGNATURE
NA :X
NA
OATE SIGNED
PARTNER'S PRINTED NAME (Lasl, [lrst, middle)
SIGNATURE
DATE SIGNED
NA
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
NA
CORPORATION
X
DATE SIGNED
~. P. INTED NAME (Lasl, flfsl, middle)
hang, Huei Liang
/;fLE
~ 0 President D Vice President
~RINTED NAME (Lasl, firsl. middle)
; hang, Tina Tieu- Tien
TITLE
o Secretary D Asst. Secretary
LIMITED LIABILITY COMPANY
D Chainnm le Board
I SIGNATURE
X"0~~'
D Chief Financial Officer D Asst. Treasurer
I DATEi'/7~/ 0 (,
11, The limited liability company is member-run
(If no, complete Item #12 below)
DYes DNo
12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, [lrsl. middle)
NA
ABC INITlALSIDA TE (ABC use only)
i DATE SIGNED
I
I
I DATE SIGNED
I
I
13 MEMBER'S PRINTED NAME (Lasl, flfSl, middle)
SIGNATURE
NA
X
MEMBER'S PRINTED NAME (Lasl, flfsl, middle)
SIGNATURE
x
ABC-211-SIG (2/03)
"SIGN ON"
1-3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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me, 0-t~dCl C, CamVlovCl /' Natovy ,~~Ij L-
Name and Tille 01 Olllcer (e,g" 'Jane Doe, Nolary Public")
'1ieU--\\CV) ChaY)~ C\hd '\+uct li C\tJ ,C~C1.hq
Name(s) of Slgner(s) ......;
State of California
County of
On
personally
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~rSOnallY known to me
~ CRtSELDA C. CASANOVA
CommIsSIon # 1654185
i ~ Notary Public "California ~
j' Santo Cloro County ~
My Comm. ExpIres Apf 23. 201
.......-------------------
o proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted,
executed the instrument.
Place Notary Seal Above
~~
'gnature 01 Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document,
Description of Attached Document ~.l+r I
Title or Type of Document: App I. ~! \;To re.-
Document Date:A~~~t- \4 Q-01J1p
Signer(s) Other Than Named Above: Y\ () \'1-e..,
C;;hee;f
Number of Pages:
Capacity(ies) Claim~d by Signer~ha
Signer's Name: ttUe-1 L..IO.2) ,:)
~dividual l..
o Corporate Officer - Title(s):
o Partner - 0 Limited 0 General
o Attorney in Fact
o Trustee
o Guardian or Conservator
o Other:
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Signer's Name: Tinci lic.u.-,iC''l
~dividual
o Corporate Officer - Title(s):
o Partner - 0 Limited 0 General
o Attorney in Fact
o Trustee
o Guardian or Conservator
o Other:
ChO\~~
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Signer Is Representing: C;Ctf-
Signer Is Representing: c:;C'tf
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<92004 National Notary Association' 9350 De Solo Ave" P.O Box 2402 ' Chalsworth, CA 91313-2402 Ilem No. 5907 Reorder: Call Toll-Free 1-800-876-6827
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