09. Whole Foods Market ABC & Liquor license
Clty-OF.
CUPEI\1INO
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER
9
AGENDA DATE f'-f}-01
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Whole Foods Market
20955 Stevens Creek Blvd~
Market
Off Sale Beer & Wine (20)
On Sale Beer & Wine--Public Premises (42)
Original Fees and Annual Fee
Reason for Application:
RECOMMENDA TION
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:
&) ~
L~::l._.t!d~J 2t.J (}zL~~p
Ciddy W ordell,ttity Planner
QyL
David W. Knapp, City Manager
Printed on Recycled Paper
9 - 1
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 2 I I (6/99)
State of California
TO: Department of Alcoholic Beverage Control
100 Paseo de San Antonio
Rm. 119
San J ase, _CA 95113
(408)277 -1200
DISTRICT SERVING LOCATION: SAN JOSE
WHOLE FOODS MARIillT CALIFORNIA INe
WfIOLE FOODS MARKET
File Number: 453866
Receipt Number: 1620562
Geographical Code: 4303
Copies Mailed Date: June 27, 2007
Issued Date:
First Owner;
Name of Business:
Locati on of B usi ness:
20955 STEVENS CREEK BLVD
CUPERTINO, CA 95014..2107
SANTA CLARA
County:
Is premise inside city limits?
....__ ..____ ____M.~1ili ng A ddr_~_s~____.__.
(If different from
premises address)
Yes
Census Tract 5078.06
5980. HORl'fON ST . _......._..._...____.__________.___
STE 200
EMERYVILLE, CA 94608-2057
Type of Ii cense( s): 20, 42
Transferor's license/name:
Yes_
322696 / WHOLE FOODS IV Dropping Partner:
No
y
y
Dup
o
o
Date
Fee
License Type
Transaction Type
Fee Type
NA
NA
Master
42 ON-SALE BEER AND ORIGINALFEES
42 ON-SALE BEER AND ANNUAL FEE
06/27/07
06/27/07
Total
$3 OO~ 00
$226.00
$526.00
Have you ever been convicted of a felony? N 0
Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the
Departlnent pertaining to the Act? No
Explain any ~IYesll 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: June 27,2007
Under penalty of peljury, each person whose signature appeal's below, certifies and says: (1) He is an applicant, or one of the applicants,. or an .
executive officer of the applicant corporation, nanled in the foregoing application, duly authorized to make this application on its behalf; (2) that
he has ];ead the foregoing and knows the contents thereof and that each of the above statements therein made are true~ (3) thnt no person other
than the applicant or applicants has any direct or indirect inlerest in (he applicant or applicanCs business to be conducted under the licensees) 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 Of transferor or to defraud or injure any creditor of transferor; (5) that the transfer application may
be wi thd ra wn by ei ther the a ppl i cant or the I icensee with no resu 1 Hng liabiI i ty to the Department.
Applicant Name(s)
WHOLE FOODS MARKET CALIFORNIA INe
Applicant Signature(s)
See 211 Sienature Paee
9-2
S ta te of Ca lifornia
APPLICATION SIGNATURE SHEET ("SIGN ON")
De partm e nt of Alcoholic Beverage Co n trol
· This form is to be used as the signature page for
applications not signed in the District Office.
· Read instructions on reverse before complet;ng~
· All signatures must be notarized in accordance with
laws of the State where signed.
2. FtLE NUMBER {if any) 3. LICENSE TYPE
t. OWNERSHIP TYPE (Check one)
42
D Sole Owner
D Partnership
o Husband & Wife
D Partnership-Ltd
4. TRANSACTION TYPE
~ Original .0 Person to Person Transfer
D Exchange 0 Premise to Premise Transfer
o Other
~ Corporation
D Linlited Liability Company
o Other
5. APPUGANT(S) NAME (Last, first, middle}
Whole Foods Market California, Inc.
6. APPLICANT'S MAILING ADDRESS (Street addresslP .0. box, city. state. zlp code)
5980 Horton St. Ste 200, Emeryville, CA 94608
7. PREMISES ADDRESS (Street address, city. zip code)
20955 Stevens Creek Blvd., Cupertino, CA 95014
APPLICANT'S CERTIFICA TION
be I~~~ ~~~ffi~~ ~~J f:~~1 i )tl:IS~~sisn a~~~~l ;~f~~ i~~~)~~pfF~ --------------K~1~1&8f ~ ~:~r~~:dj~~~~ a:la ~g~~e~hj~h e:J:~;~nj~!~iri ore- tlian-------------
the applicants, or an executive officer of the applicant application is filed with tne Department, (b) to gain or establish a
corporation, named in the foregoing aPElication, duly authorized preference to or for any creditor or transferor, or (c) to defraud or
to make this appl ication on its behalf; (2) that be/she has read Injure any creditor or transferor; (5) that the transfer application
the foregoing and knows the contents thereof and that each of the may be withdrawn by either the applicant or the licensee with no
above statements therein made are true; (3) that no person other resulting liability to the Department.
than the applicant or applicants has any direct or indirect interest I understand that if I fail to qualify for the license or withdraw this
in the applicant or applicanfs business to be conducted under the application there will be a servIce charge of one-fourth of the
licensees) for which this application is made; (4) that tbe transfer lIcense fee paid, up to $100.
application or proposed transfer is not made to (a) satisfy the
SOLE OWNER
e. PRINTED NAME (Last,lIrsl, middle) I ~GNATURE I DATE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNER'S PRINTED NAME (Last, first, midd'e)
PARTNER'S PRINTED NAME (Lastt first, middle)
SIGNATURE DATE SIGNED
X
S'GNA TURE DA TE SIGNED
X
SlGNA TURE DATE SIGNED
X
PARTNERIS PRfNTED NAME (last, first. mtddle)
Gilmore Anthon
I DATE StGNED
~ - ()S - b 7
CORPORATION
10. PRl NTE D NA M E (lastt first. m idd Ie)
TITLE
[8J President 0 Vice President 0 Chairman of the- s. oard
PRINTED NAME (Last, first, middle) I SIGNATURE
Percival, Albert E. X Signed in counterpart
TfTLE
~ Secretary D Asst Secretary 0 Chief Financial Officer 0 Asst Treasurer
LIMITED LIABILITY COMPANY
I DATE SIGNED
11. The limited liability com pa ny is mem ber -ru n
o Yes D No (If nOt complete Item #12 below)
12. NAME OF DESIGNATED MANAGER. MANAGING MEMB ER OR DESIGNATED OFFICER (Laslo first. middle)
ABC lNJTtALS/OA TE (ABC use only)
13. MEMBER'S PRINTED NAME {Last, first, midd'e}
SIGNA TURE
DATE SIGNED
x
MEMBER'S PRINTED NAME (Last, firstl middle)
I SIGNATURE
Ix
I DATE SIGNED
9-3
ABC-211-SIG (2/03)
I1S/GN ON"
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
c~r,for'1i a...
A Ii.\. Meek 0...
'L~ ".. It" 7 o &-v ~) ~ ~ Ll_ \V e.r S-lI\ f VVo~tAN1 '" Jo II C
" "" . before meT I.- fF\- J v- J ,--
Date I Name and 11 Ue of Office r (e. g. ~ llJa ne Doe. Notary P u bHc~)
personally appeared Avt~~ b,/V'1ov-e.--
Name(s) ot Signer{s)
o personally known to me - OR - ~ed 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
State of
County of
On
__ ........ ~ ...... "'^"- ~ -^- ......... .......... .A.. .#.. """- - ~
) DAVID E~ HALVERSON s:
o U COMM. # 1109874 G)
(!J HOTtJ.~~~ c~~~Nl~--n
~ COMM. EXPIRES peCt 20, 2010 ..L
Signatu re of Notary Publ ic
OPTIONAL
Though the information below is not required by la~ it may prove valuable to persons relying on the document and could prevent
fraudulent removal and rea ttachment of this form to another document.
Description of Attached Document
tVYP 1("ewH~ r 'J'Vtft 1vv-LJ~ e e1
Title or Type of Document:
Document Date:
(;!If /67
Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Signer's Name:
D J nd ividuaf
o .Corporate Officer
Title( s ) :
o Partner - 0 Limited 0 General
o Attorney-in-Fact
o Trustee
D Guardian or Conservator
D Other: Top of thumb here
o I ndivid u al
o Corporate Officer
Title( s):-
o Partner - 0 Limited 0 General
o Attorney-in-Fact
tJ Trustee
o Guardian or Conservator
D Other: Top of thumb here
Signer Is Representing:
Signer Is Representing:
@ 1995 National Notary Association" 8236 Remmel Ave.t P.o. Box 7184 · Canoga Parkj CA 91309-7184
Prod. No. 5907
Reorder; Call T oU-Free 1 ~BOO-876~6B27
State of Ca lifornja
APPLICATION SIGNATURE SHEET (&tSIGN ON")
Department of Alcoholic Beverage Control
· This form is to be used as the signature page for
a ppl ication s not sig ned in th e District Office.
· Read instructions on reverse before completing.
· All signatures must be notarized in accordance with
laws of the State where signed.
2. FJlE NUMBER (If ;my) 3. LICENSE TYPE
42
1. OWNERSHIP TYPE (Check one)
D Sole Owner
D Partnership
D Husband & Wife
o Partnership-Ltd
~ Corporation
o Linlitcd Liability Conlpany
o Other
4. TRANSACTION TYPE
~ Original 0 Person to Person Transfer
o Exchange 0 Premise to Premise Transfer
D Other
5. AP P UCANl (8) NAME (LB 5 t, first, middle)
Whole Foods Market California, Inc.
6. APPLlCANrS MAlUNG ADDRESS (Streel address/P.O. box. cny. slate~ zip code)
5980 Horton St~ Ste 200, Emeryville, CA 94608
7. PREMJSES ADDRESS (Street address. city. zip code)
20955 Stevens Creek Blvd., Cupertino, CA 95014
APPLICANT'S CERTJFJCA TION
- ...........
payment of a loan .or to fulfill an agreenlent 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
In j tlre any creditor or transferor; (5) that the transfer a p pli cat] on
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 serv]ce charge of one-fourth of the
lIcense fee paid, up to $100.
Under penalty of perjury, each person whose signature appears
belovl, certifies and say~s: (l) I-ie/She is all applicant, or one of
the applicants, or an executive officer of the applicant
corp ora ti o~, nanl~d i"!1 th e f~regoing a PQ 1 i cation, dll) Y authorized
to make thIS applIcation on Its behalf; (2) that he/she has read
the foregoing and knows the contents the.reof 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 ll1ade to (a) satisfy the
SOLE OWNER
8. PRINTED NAME (Lasl. first. middle) I ~GNAlURE I DATE SIGNED
PARTNERSHIPfLIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNERIS PRINTED NAME {Lastl first. middle}
SrGNA lURE
I DATE SIGNED
x
PARTNER'S PRINTED NAME (lastl first, middle)
SIGNA TURE
DATE SIGNED
x.
PARTNER'S PRINTED NAME (Last~ ftrst. middle)
SIGNA TURE
x
CORPORATION
DATE SIGNED
I DATE SIGNED
10. PRINTE D NAME (Last, first, middle)
I SlGNATURE
X Signed in counterpart
nTLE
~ President D Vice President D Chaim1an of the Board
-~:~~T:::;~ (L:~:~ ::d~~. . -------....- -----.-I~GM--,'.------------ ____me
TITLE
~ Secretary D Asst. Secretary 0 Chief Financial Officer
LIMITED LIABILITY COMPANY
11. .The limited liability company is member-run
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFJCER (Last, firsl, middle)
o Yes DNa (If no~ complete It
13. MEMBER'S PRINTED NAME (Last. first. middle)
SIGNATURE
x
MEMBER'S PRJNTED NAME (Last, first~ middle)
SIGNATURE
x
ABC-211-SIG (2/03)
ffSIGN ON" .
DATE SIGNED
DA TE SIGNED
9-5