06. ABC licenses
CITY OF
CUPEIUINO
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
AGENDA ITEM NUMBER
SUBJECT AND ISSUE
OFFICE OF THE CITY MANAGER
SUMMARY
~Q
AGENDA DATE June 5. 2007
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
RECOMMENDATION
Whole Foods Market California Inc.
20955 Stevens Creek Blvd. (previous Anderson Chevrolet
site)
Supermarket
Off-Sale Beer and Wine (20)
Premise-to-Premise Transfer
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:
#,
C~ Uh;'7-d/~
Ciddy Wor. ell, CIty Planner
Submitted by:
QsLL
David W. Knapp, City Manager
6-1
Printed on Recycled Paper
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Rm. 119
San Jose, CA 95113
(408)277-1200
DlSTRlCT SERVING LOCATION:
Control
File Number: 453866
Receipt Number: 1614007
Geographical Code: 4303
Copies Mailed Date: May 11,
Issued Date:
2007
Fi rst Owner:
Name of Business:
SAN .lOSE
WHOLE FOODS MARKET CALIFORNIA INC
WHOLE FOODS MARKET
Location of Business:
20955 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2107
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Yes
Census Tract 5078.06
5980 HORTON ST
STE 200
EMERYVILLE, CA 94608.2057
Type of licensees): 20
Transferor's license/name:
322696 / WHOLE FOODS Iv. Dropping Partner:
Yes_
N01
y
Dup
o
~
m
$100.00
$100.00
License Type
Transaction Type
Fee Type
Master
20 OFF-SALE BEER ANI PREMISE TO PREMISE TRANS NA
05/11/07
Total
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 queslions 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: May 11,2007
Under penalt)' 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
thun the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the Iicense(s) for
whicll 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.
agreen)enl entered inlo more than ninety (90) days preceding the day on which the transfer application is filed with the Department or to gain or
establish 0 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 cither the applicant or the licensee with 110 resulting liability to the Dcpartment.
Applicant Name(s)
WHOLE FOODS MARKET CALIFORNIA INe
Applicant Signature(s)
See 211 Sifnature Paee
6-2
Department of Alcoholic Beverage Control
Stale of 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.
I 1. OWNERSHIP TYPE (Check one)
o Sole Owner
o Partnership
o Husband & Wife
o Partnership-Ltd
~ Corporation
o Limited Liability Company
o Other
2. FilE NUMBER (il any)
3. LICENSE TYPE
4. TRANSACTION TYPE
20-322696
20
5. APPlICANT(S) NAME (Last, first, middle)
Whole Foods Market California, Inc.
6. APPUCANT'S MAILING ADDRESS (Street i1ddressn>.O. box, city, slale, zip code)
Cl Original
o Exchange
D Person to Person Transfer
181 Premise to Premise Transfer
D Other
5980 Horton St. Ste 200, Emeryville, CA 94608
7. PREMISES ADDRESS (Street address, chy. zip code)
20955 Stevens Creek Blvd., Cupertino, CA 95014 --.;#1'07
APPLICANT'S CERTlFICA TlON
Under penalty of perjury, each person whose signature appears
below, certifies and says: (J) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing apQlication, duly authorized
to make this application on its behalf; (2) that he/she has read
tlJe 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
licensees) for which tlJis application is made; (4) that the transfer
application or proposed transfer is not made to (a) satisfy the
SOLE OWNER
" PRINTED NAME (Lasl.firsl, middle) I ~GNATURE I DATE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNER'S PRINTED NAME (lasl, fIrSt. middle)
SIGNATURE
x
PARTNER'S PRINTED NAME (Las~ first, middle)
SIGNATURE
x
PARTNER'S PRINTED NAME (Lasl, first, middle)
SIGNATURE
x
ORPORATION
payment of a 10a11 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 credltor or transferor, or (c) to defr.llld or
mjure any creditor or transferor; (5) that the tf'd11sfer application
may he 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 SCTVlce charge of one-fourth of the
hcense fee paid, up to $LOO.
DATE SIGNED
DATE SIGNED
DATE SIGNED
A-A R. . AN
Notary PUbliC: S!atf" of ~ exa~
,\Ilutlllll.
~~~... "..~':"~
.. . . c
\~. .~~
""'''';''\\.~......':
;;""Jhfl~"\'"
counterpart
~~~
I ~~~NE~
10. PRINTED NAME (Last, first, middle)
Gilmore, Anthony M.
TITLE
j SIGNATURE
X Signed in
~ President D Vice President
PRINTED NAME (las~ first, middle)
'vi
/ Percival, Albert E.
TITLE
l8J Secretary 0 Asst. Secretary 0 Chief Financial Officer D Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run
DYes DNo
(If no, complete Item #12 below)
I ABC INITIALSJOATE (ABC use only)
-I DATE SIGNED
I
i DATE SIGNED
I
12, NAME OF DESIGNATED MANAGER. MANAGING MEMBER OR DESIGNATED OFFICER (lasl. first, middle)
'1. MEMBER'S PRINTED N(\M€ (Lasl, f.s~ middle)
SIGNATURE
X
MEMBER'S PRINTED NAME (Lasl, filS~ middle)
SIGNATURE
X
ABC-211-SIG(2103) (
,ft' 04.' r
.~ h'- III ^
IIS/GN ON"
6-3
Sti:lte of California
APPLICATION SIGNATURE SHEET (USIGN 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.
3, LICENSE TYPE
2. FILE NUMBER (if my)
20-322696
20
5, APPUCANT(S) NAME (Lasl first, middle)
Whole Foods Market California, Inc.
6. APPLlCANT'S MAILING ADDRESS (StreeladdressIP.O. box, city. state. zip code)
5980 Horton St. Ste 200, Emeryville, CA 94608
7. PREMISES ADDRESS (Slreet address, clly, zip code)
I 'B~i~F.~:~;-'
o Husband & Wife
o Pm1nership- Ltd
4. TRANSACTION TYPE
I 0 Original D Person to Person Transfer
o Exchange ~ Premise to Premise Transfer
! D Other
,
~ Corporation
D Limited Liability Company
D Other .
20955 Stevens Creek Blvd., Cupertino, CA 95014
APPLICANT'S CERTIFICATION
payment of a loan or to fulfill an Hl!reement entered into more than
ninety (90) days preceding the daion which the transfer
application is filed with die 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 tbe applicant or the licensee with no
reslllting liability to the Department.
I understand that if I fail to <{ualif)' for the license or ....'ithdraw this
application there will be a servIce charge of one-fourth of the
license fee paid, up to $ 100. ..
Under penalty of perjUry, each person whose signature appears
below, certifies and says: :(1) He/She is an applicant, or one of
tbe applicants, or an executive officer of tbe applicant
corporation. named in the foregoing aPI?Iication. duly autllOrized
to make this application on its behRIf; (2) that he/she has read
the foregoing and knows tbe contents thereof and that each of the
above statements therein made are true; (3) that no person other
than the applicant or applicants lIas any direct or indirect interest
in the applicant or applicant's business to be conducted under the
Iicense(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 (last. tirot, middle) I ~GNATURE I DATE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
SIGNATURE DATE SIGNED
X
SIGNATURE DATE SIGNED
X
SIGNATURE DATE SIGNED
X
. 9, PARTNER'S PRINTED NAME (lasl. first, middle)
PARTNER'S PRINTED NAME (Lasl first, middle)
PARTNER'S PRINTED NAME (LasL frst, middle)
CORPORATION
10. PRINTED NAME (Last. f.st, middle)
Gilmore, Anthony M.
TITLE
IDA TE SIGNED
i.t - 3 - ,..:,..~..
181 President 0 Vice President
PRINTED NAME (last. first, middle)
D Chainnan of t. ~ oard
I SIGNATURE
IX Signed in counterpart
I DATE SIGNED
I
Percival, Albert E.
TITLE
~ Secretary 0 Asst. Secretary 0 Chief Financial Officer D Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run
DYes DNo
(If no, complete Item #12 below)
i ABC INITIALSIDATE (ABC use only)
I
I
I DATE SIGNED
I DATE SIGNED
I
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lasl firsl middle)
13. MEMBER'S PRINTED NAME (Last, first, middle)
~TURE
[ ~GNATURE
IX
"SIGN ONn
MEMBER'S PRINTED NAME (Last, flrsl middle)
ABC-211-SIG (2/03)
6-4
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of
C~l~fort1i ~
A l~Mecla...
County of
On "'0-(';\ ~(',,{'- LOC/1-
Dale
personally appeared \/4"" ~t-., ~""\
o personally known to me - OR 4proved 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 hislher/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.
TODD P. CONNORS~
COMM. # 1-45&322 n
NOTARY pUBUC-CALfORNIA VI
^LAMEDA: COUNTY 0
COMM. EXP. DEC. 14, 2007....
WITNESS m!,.~~,:~~~f}d'15ffiCial seal. ,/
// /.../ ~ .--;;7 ~.
~?~/:.r- c:;...e-
/' /ignalure of Notary Public
,,<JPTIONAL
Though the information below is not required by Jaw, 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
Title or Type of Document: tfrp p ~~ c.cv~i u--.... ) t ~ t-'..-v/v.-
Document Date: ~ 'Ii I '5 ..r.). 'Zoo .;r- Number of Pages: ---L-
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Signer's Name:
o Individual
o Corporate Officer
Title( s):
o Partner - 0 Limited 0 General
o Attorney-in-Fact
o Trustee
o Guardian or Conservator
o Other: Top of lhOmb here
RIGHT THUMBPRINT
OF SIGNER
o Individual
o Corporate Officer ....--..../..
Trtle{s}: ._-----~'
....-"-
o Partner - I:H::imited 0 General
,..-.-
o Attp,mey-in-Fact
....-Ia-Trustee
o Guardian or Conservator
o Other: Top of thumb here
RIGHT THUr,1BPRINT
OF SIGNER
Signer Is Representir)Q:
Signer Is Representing:
C 1995 National Notary Association' 8236 Remmel Ave.. P.O. Box 7184 . Canoga Park, CA 91309. 718~
Prod. No. 5907
Reorder. Call Ton-Free 1-80D-87&-682.7
CITY'F
CUPEIQ"INO
AGENDA ITEM NUMBER
SUBJECT AND ISSUE
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
(06
AGENDA DATE June 5.2007
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
RECOMMENDATION
Sushi Tatsumi
19754 Stevens Creek Blvd (Marketplace Shopping Center)
Restaurant
On-Sale Beer and Wine for Bona Fide Public Eating Place (41)
Original Fees. Annual Fee & State Fingerprints
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:
C'~c?J~
Ciddy Wor ell, CIty Planner
Submitted by:
~
David W. Knapp, City Manager
6-6
Printed on Recycled Paper
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Rm. 119
San Jose, CA 95113
(408)277-1200
DISTRICT SERVING LOCATION:
Control
File Number: 454131
Receipt Number: 1615139
Geographical Code: 4303
Copies Mailed Date: May 18, 2007
Issued Date:
First Owner:
Name of Business:
SAN .JOSE
TA TSUMI LLC
SUSHI T A TSUMI
Location of Business:
19754 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2456
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Yes
Census Tract 5080.01
Type of licensees): 41
Transferor's license/name:
/
Dropping Partner:
Yes_
NoJ
License Type
Transaction Type
Fee Type
NA
NA
NA
Master Dup Date
y 0 05/18/07
Y 0 05/18/07
N 1 05/18/07
Total
Fee
$300.00
$304.00
$39.00
$643.00
4] ON-SALE BEER AND ORIGINALFEES
41 ON-SALE BEER AND ANNUALFEE
41 ON-SALE BEER AND STATE FINGERPRINTS
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 10 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: May 18,2007
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 tltis 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 Iicense(s) for
which this application is made; (4) that the transfer application or proposed tnIDsfer is not made to satisfy the payment of a loan or to fulfill an
ngreement 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)
TATSUMI LLC