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08. Alcoholic Beverage License CITY OF CUPEIUINO City Hall 10300 Torre A venue Cupertino, CA 95014 (408) 777-3212 Fax: (408) 777-3366 AGENDA ITEM NUMBER SUBJECT AND ISSUE OFFICE OF THE CITY MANAGER SUMMARY ta, AGENDA DATE: December 5. 2006 Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application: RECOMMENDATION Paul and Eddies Associates, Inc. 21619 Stevens Creek Blvd. (near Hwy 85) Bar On-Sale General for Public Premises (48) Person-to-Person Transfer 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: /71 L L!c._~ .~A; 1~)(J-~~J7 Ciddy Worden: City Planner Submitted by: ~ David W. Knapp City Manager G: \PlanningIMISCELL IABClabc paul&eddiesassociates. doc Printed on Recycled Paper o~ ~- ( State of California Department of Alcoholic Beverage Control APPLICA TION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC :!II l(lfl)9) TO: Department of Alcoholic Beverage 100 Paseo de San Antonio Room 119 San Jose, CA 95113 (408) 277-1200 DISTRICT SERVING LOCATION: First Owner: Name of Business: Locati on of B Llsi ness: County: Is premise inside city limits? Mailing Address: (If di fferent from premises address) Type of license(s): 48 Transferor's license/name: Control File Number: 447456 Receipt Number: 1590047 Geographical Code: 4303 Copies Mailed Date: Novemher 2, 2006 Issued Date: SAN JOSE PAUL AND EDDIES ASSOCIATES INC PAUL & EDDIES MONTE VISTA INN 21619 STEVENS CREEK BLVD CUPERTINO, CA 95014-1168 SANT A CLARA Yes Census Tract 5078.05 21710 STEVENS CREEK BLVD STE 200 CUPERTINO, CA 95014 335412 / FREESOLO INC Dropping Partner: Yes No Fee License Type Transaction Type Fee Tvpe Master Dup Date 48 ON-SALE GENERAL. PERSON TO PERSON TRAt\:SF P40 Y 0 11101106 48 ON-SALE GENERAL: ANNUAL FEE P40 y 0 11101106 30 TEMPORARY PERMI DUPLICATE NA y 1 11/01106 48 ON-SALE GENERAL STATE FINGERPRINTS NA N 2 11101106 Total $1,250.00 $758.00 $100.00 $78.00 $2,186.00 Have YOLl 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: November 1,2006 Under penally of pe,jury. 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 tllereof and that each of the above statements therein made are true; (3) that no person other than the applicant or applicallls has any direct or indirect interest in the applicant Dr applicant's business to be conducted undcr the licensers) 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 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 II preference to or for an)' creditor oJ' 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) PAUL AND EDDIES ASSOCIATES INC Applicant Signature(s) ~pp 211 ~ienHtllrP PHgP (j l\ -1.. Department of Alcoholic Beverage Control State of California APPLICATION SIGNATURE SHEET ("S/GN 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. 2. FILE NUMBER (If any) I ' uce",,,,,, I 48 5. APPLlCANT(S) NAME (Last, first, middle) Paul and Eddie's Associates Inc. 1. OWNERSHIP TYPE (Check one) D Sole Owner o Partnership D Husband & Wife : D Partnership-Ltd 1 4, TRANSACTION TYPE I i D Original j D Exchange ~ Corporation D Limited Liability Company o Other 1iJ Person to Person Transfer D Premise to Premise Transfer D Other 6 APPLICANT'S MAILING ADDRESS (Slreel address/P.O. box, CilY, stale, zip code) 21710 Stevens Creek Blvd., Cupertino CA 95014 Suite 200 7. PREMISES ADDRESS (Street address, city, zip code) 21619 Stevens Creek Blvd. Cupertino CA 95014 APPLICANT'S CERTIFICA TlON 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 ap,Elication, 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 SOLE OWNER 8. PRINTED NAME (Lasl, lir>l. middle) .1 ~GNATURE I DATE SiGNED PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) 9 PARTNER'S PRINTED NAME (Lasl. flrsl. middle) SIGNATURE ! DATE SiGNED X 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 filt::c.I with the Department, (b) to gain or establish a preference to or for any creditor or transferor, or (c) to defraud or mjure 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 1 fail to qualify for the license or withdraw thiS application there will be a service charge of one-fourth of the hcense fee paid, up to $100, PARTNER'S PRINTED NAME (Last, first, middle) SIGNATURE X SIGNATURE PARTNER'S PRtNTED NAME (Last. first. middle) X CORPORATION I DATE SIGNED I I l-DATE SIGNED , DATE SIGNED I {olz.S,/ol.:. 10. PRINTED NAME (Lasl, 11r>t. middle) .J 76-R-:5/ IV' / TITLE s. ~ President D Vice President PRINTED NAME (Lasl, firsl, middle) lIef!..:) l,j I, /v7M2-k f. TITL E / [;a Secretary D Asst. Secretary D Chief Financial Officer D Asst. Treasurer LIMITED LIABILITY COMPANY I DATE SIGNED , 0 I 2-~ } 0 I",. 11. The limited liability company is member-run (If no, complete Item #12 below) ABC INITIALSIDA TE (ABC use only) DYes DNo 12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, firsl. middle) DATE SIGNED SIGNATURE DATE SIGNED 13 MEMBER'S PRINTED NAME (Last. first, middle) X MEMBER'S PRINTED NAME (Last, firsl, middle) SIGNATURE X ABC-211-SIG (2/03) "SIGN ON" JC(-J State of ea I, ~~)I '" \ '" Notary Acknowledgement , County of SoY\""\~ L \~rL, On I f) - L 'S -0(., --r ' . \' L VI/tV,::> before me, Jt-nn\'\u J.,(lc,.;n /\I~~, personally appeared K(nf'<1\.- S. Tc/...,'nl ersonally known to me OR - proved to me on the basis of satisfactory evidence 0 e e person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that ~/she/they executed the same in~/her/their authorized capacity (ies), and that byt1iTsVher/their signatures on the instrument the person(s), or the entity upon b~lf of which their person(s) acted, executed the instrument. WITNESS my hand and official seal. NOTARY IMPRESSION HERE 9- -/)u ;-%7 ( '- h~--'" . - tOTAAY SIGNATURE J-----:::----J -a COI~~aa ~ J -...- . CallIamIO · IanIa CIafa COU'1IV - __ _ _ ~~:.~-"!2~~ Notary Acknowledgement State of (ai, 401' (I I '~j On 10" L S-o(, , County of Sa n1 Co e-lq rc, '1) n [' , Jo}.:tcl"f before me,Jenn,(i-,. J...l",;." rv~J..,-. , personally appeared .J11ar ~ 6' 1('''~/:'i , personally known to me OR - proved to me on the basis of satisfactory evidence 0 erson(s) whose name(s) ~are subscribed to the within instrument and acknowledged to me that ~she/they executed the same in@/her/their authorized capacity(ies), and that by@/her/their signatures on the instrument the person(s), or the entity upon behalf of which their person(s) acted, executed the instrument. WITNESS my hand and official seal. NOTARY IMPRESSION HERE c.:-~J~=/ ~:2dG / I' NOT.t<Ry SIGNATURE J-----:::----f _. ClA~~aa ~ J -...- - CallIamIO · IanIa ClarO COU'1IV - _ _ _ ~~_~_,,!2~~ JCl-Y CITY OF CUPEIUINO City Hall 10300 Torre Avenue Cupertino, CA 95014 (408) 777-3212 Fax: (408) 777-3366 OFFICE OF THE CITY MANAGER SUMMARY AGENDA ITEM NUMBER ~ b AGENDA DATE December 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: California Pizza Kitchen 19621 Stevens Creek Blvd (Val1co Fashion Park) Restaurant On-Sale General for Bona Fide Public Eating Place (47) New Application RECOMMENDATION There are no use permit restrictions or zoning restrictions which would prohibit this use and staff has no objection to the issuance of the license. Prepared by: Submitted by: ~, Gf..-d:~.L . dCJ2&!L~/ Ciddy Wor ell, City Planner J1K David W. Knapp, City Manager G: IPlanninglMISCELL \A BClabc CaliforniaPizzaKitchen. doc J h--I Printed on Recycled Paper Department of Alcoholic Beverage Control APPLICA TION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 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: 445766 Receipt Number: 1590656 Geographical Code: 4303 Copies Mailed Date: November 7, 2006 Issued Date: First Owner: Name of Business: SAN JOSE CALIFORNIA PIZZA KITCHEN INC CALIFORNIA PIZZA KITCHEN Location of Business: 19621 STEVENS CREEK BLVD CUPERTINO, CA 95014-2422 SANTA CLARA County: Is premise inside city limits? Mailing Address: (If different from premi ses address) Yes Census Tract 5081.01 6053 W CENTURY BLVD 11TH FLR COMPLIANCE & LICENSING LOS ANGELES, CA 90045 Type of license(s): 47 Transferor's license/name: Dropping Partner: Yes No y Dup o Date Fee License Type Transaction Type Fee Type P40 Master 47 ON-SALE GENERAL] ANNUAL FEE 11/07/06 Total $758.00 $758.00 Have YOLl ever been convicted of a felony? No Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertai ni ng 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: November 7,2006 Under penalty of perjury, each person whose signature appears below, certifies and says: (I) 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 thall the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be coi1ducted under the licensees) for which tillS 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 agreemcnt 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 ur 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) CALIFORNIA PIZZA KITCHEN INC Applicant Signature(s) Spp 211 Sien~tllrp PHep 6b--2- State of California APPLICATION SIGNATURE SHEET ("SIGN ON") Department of Alcoholic Beverage Control 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. 1 OWNERSHIP TYPE (Clleck one) o Sole Owner o Partnership o Husband & Wife o Partnership-Ltd 12] Corporation o Limited I .iability Company o Other 2 FILE NUMBER (If any) 3 LICENSE TYPE 4. TRANSACTION TYPE ~ 0 Oliginal 0 Person to Person Transfer o Exchange 0 Premise to Premise Transfer ,47 [2] Other 2000 PRIORITY WINNER 445766 G APPLlCANTIS) NAME (Last. IlfSI, middle) CALIFORNIA PIZZA KITCHEN INC (P-I2) 6 APPLICANT'S MAILING ADDRESS (SlIeel address/P 0 box. cily. slale. zip code) 6053 W Century I3Ivd, II Ih Fl., Los Angeles, CA 90045 7 PREMISES ADDRESS IStreet address. city. Zip code) ,C(lJ,'ZI 5 teve nc:.> Cr~f,k B\Vd, 1 CUPERTlINO, CA 95014 APPLICANT'S CERT/FICA T/ON Under penalty of pelJury, each pcrson whose signature appears below, certiftes and says: (I) He/She is an applicant, or one of the applicants, or an executive officer of the appltcant corporation. namcd In thc foregolllg application, duly authorized 10 make thiS application on its behalf: (2) that he/she has read tlte foregoing and knows [he contents thereof and that each of the abovc statcments therell1 made are tl'ue; (3) that no person other than the applicant or a!)plicants has any direct or indirect interest in the applicant or ap\) ieant's bUSiness to bc conducted under the lieense(s) for which t liS application IS made; (4) that the transfer application or proposed transfer is not made to (a) satisfy the payment ofa loan or to fulfill an [Igreement entered Into more than ninety (90) days preceding tbe day on which thc transfer application is filed with the Department, (b) to gain UI' eSlablish a preferencc to or for any creditor or transfcror, or (c) to defraud or IIljure any creditor or transferor; (5) that the transfer appliealton may be wIthdrawn by either the applicant or the licensee with no resulling liabilitv to the Department. lundcrstand that if I fail to qualify for the license or wllhdraw this application there will be a service charge of onc-foul.th of the license fee paid, up to $100. SOLE OWNER PARTNERSHIP/LIMITED PARTNERSHIP I ~GNATURE (Signatures of general partners SIGNATURE 8 PRINTED NAME [Last. first. ITIiddle) 9. PARTNER'S PRINTED NAME (Lasl. firSt. ITIlddle) 'X I DATE SIGNED only) I DATE SIGNED I I I DATE SIGNED DATE SIGNED PARTNER'S PRINTED NAME (Lasl. first. middle) SIGNATURE x PARTNER'S PRINTED NAME (Last. first. middle) SIGNATURE IX CORPO RATION 10 PRINTED NAME (Lasl. flfst. middle) COLLYNS, SUSAN MARGARETTA I DATE SIGNED i /o/zz/ob r / ") V TITLE .r IV 0 President I 12] ice President ~RINTED NAME (Lasl. firsl. mi die 1.v CaLL Y!!..S, SUSAN MARGARETTA I TITLE '..\ C~ecretary 0 As~t Secretary LIMITED LIABILITY COMPANY I ~~ SI;~~ 11. The limited liability company is member-run o Yes DNa (If no, complete Item #12 below) 12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lasl, first. middle) i ABC INITIALSIDA TE (ABC use onlyl I . i_______ I DATE SIGNED DATE SIGNED 13 MEMBER'S PRINTED NAME (Last. flfsl. middle) SIGNATURE X MEMBER'S PRINTED NAME (Last. flfsl. IllIddle) SIGNATURE ABC-21 T 12/0 X ~~) 6 ':r;;~ ob-- 3 ~~ CALlFORNIA ALL-PURPOSE ACKNOWLEDGMENT f-O<>,c{'.,c{'.c<'.c(',c{'.c<:'.(X'.<X'.<X',,<:;<><x'.<X'.c<',,<X'..c<',C{',b('.c<'.c<'-<X'.c<'.c<'.c<'d:X',(X'vC<'..c<'.c<:'.c<'.c<'..c<',c<><XA:X'A:X'-<X'vC<',a.~ ~ ~ ~ g ~ State of callfornia}1 /1 / } ss, ~ i Cocol, 01 ~. ~lvfu i ~ On /O/;z 7/0, before me, ,,1I1fPI-IJ CIIuYIC- - #OT~j /lIw~ ~ ~ I Dale C, ~/J . J /"'i_;~m:;~ T: of Officer le.g.. "Jane Doe. Notary Putl,e') g~, I ~ personally appeared JVJ "4 ~~> '~II r6 Name(s) .ot 'igner(s) I i to be the person(s) whose name~ is/afeo ~ subscribed to the within instrument, and I J -. - - - - - - - -. -. -. ~ J acknowledged to me that-l:le/she/#ley exticuted I ~ MARLA Y. CHUSAC the same in ~er/t~ authorized Commission # 1597151 capacity(ies), and that by ~/her/t~ ~ ..... Notmy ,"bUc . Catllomlo f ,igoal",e(,) 00 Ihe ,,,Ice me" Ihe pe",oo( ,), DC ~ ~ ~ Los Angeles Cotny .......l the entity upon behalf of which the person(s) ~I I J _ _ _ :V:o:m._~~2~~! acled, mecled Ihe io"'cmeot I I ~ % ~ ~ ~ ~ ~.': ~ ~ g 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 ~ I TilleocTypeofDoccmeot ;9BG -(1 ~ ~ Document Date: Number of Pages: I ~ ~. Signer(s) Other Than Named Above: ~ i Capacity(ies) Claimed by Signer I ~. Sigo,,', Name ,S;~1tN CUjN5. I \\' = ~idual C J/ [) d L , LU VI .JIC /'" CA Top of thumb here g g ~';~~orate Officer - Title(s): Jt. y r r.r r1"y1"'/V\...iO-. ~ u ~ ~ 0 Partner - n Limited 0 General " g ~ 0 Attorney-in-Fact g ~ 0 Trustee 2; ~ U Guardian or Conservator g ~ 0 Other: ~ J~L>>AH efi g ~ Sigoe'" Rep""""09 (TV-~ rY?' ~ k('~ ~ ~'C(.'G(,'C(.'C(.~'<X:;'G(.xx.xx.xx.'C<-'C<-'C<-'Q<;.'G<;.'G<-'C<;C(''C(.~<X'<'X'Q<;.~xx.'C<'~';:X;G/~"G<;{X':,'C(.'C(.'C(.'C(.~-:;<:;(.~'Q'~ ersonally known to me n proved to me on the basis of satisfactory evidence @ 1999 National Notary Association' 9350 De Solo Ave., P.O. Box 2402 . Chatswor1h, CA 9131:3"2402' www.NationaINotary.org Prod. No 5907 Reorder" Call Toll-Free 1-AOO-876-6827 6b.-y City Hall 10300 Torre Avenue Cupertino, CA 95014 (408) 777-3212 Fax: (408) 777-3366 CITY OF CUPEIUINO OFFICE OF THE CITY MANAGER SUMMARY AGENDA ITEM NUMBER Dc' AGENDA DATE December 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: Homestead FFC Inc. 20990 Homestead Road Bowling Alley 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: Submitted by: fI' L~ t;ll ~ David W. Knapp, City Manager G: IPlanninglMISCELL \ABClabc HomesteadBowlInc. doc gc -/ Printed on Recycled Paper c.S~ 1 State of California Department of Alcuhulic Beverage Control APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6/99) TO: Department of Alcoholic Beverage 100 Paseo de San Antonio Room 119 San Jose, CA 95113 (408) 277-1200 DISTRICT SERVING LOCATION: First Owner: Name of Business: Location of Business: County: Is premise inside city limits? Mailing Address: (If different frum premi ses address) Type of licensees): 47 Transferor's license/name: Control File Number: 447926 Receipt Number: 1591866 Geographical Code: 4303 Copies Mailed Date: November 17, 2006 Issued Date: SAN lOSE HOMESTEAD FFC INC HOMESTEAD LANES 20990 HOMESTEAD RD CUPERTINO, CA 95014-0355 SANTA CLARA Yes Census Tract 5078.05 21997 VERNON RIDGE DR MUNDELEIN, IL 60060 443066 / MALLEY GREGOR Dropping Partner: Yes No --:t- Fee License Type Transaction Type Fee Type Master Dup Date 47 ON-SALE GENERAL] PERSON TO PERSON TRANSF P40 y 0 11117/06 47 ON-SALE GENERAL] ANNUAL FEE P40 Y 0 11117/06 30 TEMPORARY PERMI DUPLICATE NA y I 11117/06 47 ON-SALE GENERAL] STATE FINGERPRINTS NA N 2 11117/06 47 ON-SALE GENERAL] FEDERAL FrNGERPRINTS NA N 2 11117/06 Total $1,250.00 $758.00 $100.00 $78.00 $48.00 $2,234.00 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: November 17, 2006 Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He is an applicant, 01' 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 tlHIl cacll of the above statements therein made are true; (3) that no person other than tile applicant or applicants has any direct or indirect interest in the applicant 01' applicant's business to be conducted under tile Iicense(s) for which thiS application is made: (4) that tile transfer application or proposed lransfer 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 1I preferellce to 01 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) HOMESTEAD FFe INC If).~~ ~-~/ 2'Y'~ g- (- ;;L cJ~~ Department of Alcoholic Beverage Control APPLICA TION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (CI/99) State of California TO: Department of Alcoholic Beverage 100 Pas eo de San Antonio Room 119 San Jose, CA 95113 (408) 277-1200 DISTRICT SERVING LOCATION: Control File Number: 447926 Receipt Number: 1591866 Geographical Code: 4303 Copies Mailed Date: November 17, 2006 Issued Date: First Owner: Name of Business: SAN JOSE HOMESTEAD FFC INC HOMESTEAD LANES Location of Business: 20990 HOMESTEAD RD CUPERTINO, CA 95014-0355 SANTA CLARA County: Is premise inside city limits? Mailing Address: (If different from premises address) Yes Census Tract 5078.05 21997 VERNON RIDGE DR MUNDELEIN, IL 60060 Type of license(s): 47 Transferor's license/name: 443066 / MALLEY GREGO~ Dropping Partner: Yes No -X- License TVDe Transaction Type Fee Type Master Dup Date 47 ON-SALE GENERAL J PERSON TO PERSON TRANSF P40 Y 0 11/17/06 47 ON-SALE GENERAL) ANNUAL FEE P40 y 0 11/17/06 30 TEMPORARY PERMI DUPLICATE NA y I 11/17/06 47 ON-SALE GENERAL I STATE FINGERPRINTS NA N 2 11/17/06 47 ON-SALE GENERAL I FEDERAL FINGERPRINTS NA N 2 11/17/06 Total Fee $1,250.00 $758.00 $100.00 $78.00 $48.00 $2,234.00 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 allY "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: November 17,2006 Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He is an applicant, or one of the applIcants, ur an executive officer of the applicant corporation, named in the foregoing applIcation, duly authorized to make this application on its behalf; (2) thai he has read the foregoing and knows the contents thcrcof and that each of the above statements therein made are true; (3) that no person other than thc applicant or applicants has any direct or indirect interest in the applicant or applicant's husiness 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 ti,e 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 cswblish a rreference to or for 'lilY creditor or transferor or to defraud or injure any creditor of transferor; (5) that the transfer application may be withdrawn b)' either the applicant or the licensee with no resulling liability to the Department. ~).~~ ~-r~/ Applicant Name(s) HOMESTEAD FFC INC HECEIVED NOV 2 02.006 tc.-J