14a. ABC Green Valley LiquorCity Hall
10300 Torre Avenue
Cupertino, CA 95014
{408) 777-3212
Fax: {408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER ~'-~ a--
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1. Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
RECOMMENDATION
AGENDA DATE May G, 2008
Hoang A. Cuong (Green Valley Liquor)
10073 Saich Way
Liquor Store
Off-Sale General {21}
Person-to-Person & Annual Fee
There are no use permit restrictions or zoning restrictions that would prohibit this use and staff
has na objection to the issuance of the license.
Prepared by:
Colin Jung enio nner
G:planning/mi sc/abcgreenval leyliquor
Submitted by:
David W. Knapp, City Manager
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Priniari nn RwrvrJarl Panar
Depat•tment of Alcoholic Beverage Control State of California
APPLICATION TOR ALCOHQLIC BEVERAGE LICENSES}
ABC 211 (G/9))
TO: Department of Alcoholic Beverage Control File Number: 465716
100 Paseo de San Antonio Receipt Number: 1658348
Rm. 119 Geographical Code: 4303
San Jose, CA 95113 Copies Mailed Date: April 4, 2008 -
(408)277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN .LOSE
First Owner: HOANG CUONG A
Name of Business: GREINVALLEYLIQUOR
Location of Business: 10073 SAICH WAY
CUPERTINO, CA 95014-2124
County: SANTA CLARA
Is premise inside city limits? Yes Census Tract 5078,06
Mailing Address:
(If different from
premises address)
Type of license(s): 21
Transferor's license/name: 457697 / PEREZ ROBERTO Dropping Partner: Yes No ~-
License Tvne Transaction Tyke Fee Master Dun ate ~
21 OFF-SALE GENERAL PERSON TO PERSON TRANSF NA Y 0 0 4 /0 4 /0 8 $1,274.00
21 OFF-SALE GENERAL ANNUAL FEE NA Y 0 04/04/08 $507.00
21 OFF-SALE GENERAL FEAERAL FINGERPRINTS NA N 1 0 4/ 0 4/ 0 8 $24.00
21 OFP-SALE GENERAL STATE FINGERPRINTS NA N 1 0 4/ 0 4/ 0 8 $39.00
Total $1,844.00
Have you ever been convicted of a felony? N o
Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the
Department pertaining to the Act? No
Explain any "Yes" answer to the above questions on art attachment which shall be deemed part of this application,
Applicant agrees (a) that any manager employed in an on-sale licensed premise will have alI the
qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the
provisions of the Alcoholic Beverage Control Act.
STATE OF CALIFORNIA County of SANTA CLARA Date: April 4, 200$
Under penalty of perjury, each person whose signalurc appears below, certifies aad says: (1) He is an applicant, or one of the applicants, or an
executive ofricer of the applicant corporation, natued io the foregoing application, duly authorized to make this application on its behalf; (2) thrt
he has read the foregoing and knows the contents thereof and that each of the above statements therein made are true; (3) tlrat no person other
(Iran the applicant or applicants has any direct or indirect interest in Lire applicant or applicant's business to be conducted under the JicensC(s) for
which this application is made; (4) that lire transfer application or proposed transfer is not etude to satisfy the payment of a loan or to fulfill an
agreement entered into more than ninety (40) days preceding the day on which the transfer application is filed with [Ire 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 eilhcr Lire applicant or the Licensee with no resulting liability to the Department,
Applicant Natne(s) Applicant Signature(s)
HOANG CUONG A See 211 ~ignatrrre P~g~.
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State of California Department of Alcoholic Beverage Control
APPLICATION SIGNATURE SHEET ("SIGN ON")
• This form iS to be used as the signature page for 1. OWNERSHIP TYPE {Ct>edc one)
applications not signed in the District Office. /^ Sole Owner ^ Corporation
• Read instructions on reverse before completing. ~ Partnership ^ Lirruted Liability Company
• All signatures must be nofarized Jn accordance with ^ Husband & Wife ^ Other
laws of the State where signed ^ Partnership-Ltd
2. FlLE NUMBER (ft any) 3. LICENSE TYPE 4. TRANSACTION TYPE
^ Original ^/ Pelson to Person Transfer
21 ^ Exchange ^ Premise to Premise Transfer
^ Other
5. APPLICANT(S) NAME (Lest, first, middle)
Hoang, Cuong Anh
6. APPLICANTS MAILING ADDRESS (Street address/P,O, box, city, state, zip code)
100 Branham Ln E Apt 3114, San Jose, CA 95111
7. PREMISES ADDRESS (street address, dry, zip code)
10073 Saich Way, Cupertino, CA 95014
APPLICANT'S CERTIFICATION
Under penalty of perjury, each pperson whose signature appears payment of a loan or to fulfill an agreement entered into more than
below, certifies and says: (1) He/She is an applicant, or one of ninety (90) days preceding the day on which rite transfer
the applicants, or an executive officer of the applicant application is filed with the Department, (b) to ain or establish a
corporation, named in the foregoing ap lication, duly authorized preference to or for any creditor or transferor, or ~c) tD defraud or
to make th-s application on its behalf; ~) that helshe 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 nD person other resulting liability to the Department.
than the applicant or appplicants has any direct or indirect interest I understand that if I fail to quali~y for rite license or withdraw this
in the a Picant or applicant's business to be conducted under rite application there will be a service cfiarge ofone-fourth of the
license~s~ for which this application is made; (4 that the transfer license fee paid, up to $100.
application or proposed transfe-• is not made to ~a) satisfy the
SOLE OWNER ,
8. PRINTED NAME (Last, titer, mddle) SIGNAT DATE SIGNED
Hoang, Cuong Anh X ~_~ ~~~~ '
PARTNERSHIPILIMITED PARTNERSHIP (Sig res of genet partners only}
9. PARTNERS PRINTED NAME (Last, Brst, mkidle) SIGNA E DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, fas4 middle) SIGNATURE DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, Est, mMde) SIGNATURE DATE SIGNED
X
CORPORATION
10. PRINTED NAME (Last, lust, midde)
DATE SIGNED
TITLE
^ President ^ Vice President ^ Chairman of the Board
PRINTED NAME (Last, tirs4 middle) (SIGNATURE l DATE SIGNED
X
TITLE
^ Secretary ^ Asst. Secretary ^ Chief Financial Officer ^ Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run ^ Yes ^ No (If no, wmplete Item #12 below)
72. NAME OF DFSIGNATF~ MANAGER MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, midde) ABC INITIALS/DATE (ABC use ordyJ
13. MEMBER'S PRINTED NAME (Lest, Brat, middle) SIGNATURE DATE S1(~D
X
MEMBER'S PRINTED NAME (teal, ffrat, midde) SIGNATURE DATE SIGNED
X
ABC-211-SIG (2103) "SIGN ON"
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of Caiifornia n~ nn
County of ~Gl t/l,~ G1. C~O(~c,Gy
7 '
On ,~,3_t~~i2_S' before me, k L(t/1 N ~ 1 N A ~ f U0 ~ T1~ e G,
Dare Here Insert Name and TIBe of the Ollicer
personally appeared C~U n )1~ (x A N ~-i ~5~~~rA~ NGr
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name{s} i 'are subscribed to the
within instrument and acknowledged to me that
he she/they executed the s e in his/her/their authorized
apacity(ies}, and that b hi her/their signature(s) on the
ins#rument the person(s), or the entity upon behalf of
which the person{s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
T KIM N. PRAM of the State of California that the foregoing paragraph is
U COMM. # '!601639 ~ true and correct.
: NOTARY PU9LIC - CALtFORNtA +~
SANTA CLARA COUNTY {~
COMM. EXPIRESAUG19,2009 ~` WITNESS my hand and official seal.
Signature
Place Notary seal Abore ~ ~ gnat 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
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
^ Individual ^ individual
^ Corporate Officer -Title(s): ^ Corporate Officer -.Title(s):
^ Partner - O Limited ^ Genera! ^ Partner - ^ Limited ^ General _ _ _
^ Attorney in Fact - • ~' O Attorney in Fact • -
^ TrUStee Top of thumb here ^ Trustee 7oP ~ thumb !,ere
^ Guardian or Conservator ^ Guardian or Conservator
^ Other:. ^ Other:
Signer Is Representing: Signer Is Representing:
®2007 Natlonal Ndary Assodalbn •8360 De Solo Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • rmw.NalfoneMldaryag qem 1F5907 Reorder. Call ToU-r-ree 1-~0.876.8827
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