16. ABC Aqui Cal MexOFF{CE OF THE CITY ;MANAGER
CUPERTINO
CITY HALL
10300 TORRE AVENUE_ • CUPERTINO, CA 950143255
TELEPHONE: {408) 77'?-3212 • FAX: {408) 777-3366
SUMII~ARY
AGENDA ITEM NUMBER
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
AGENDA DATE ~ ~ ~ ~% ~~ G~ `~
1. Name of Business: Aqui Cal MeK
Location: 10630 South De Anna Boulevard
Type of Business: Restaurant
Type of License: On-Sale General for Bona Fide Public Eating Place (47}
Reason for Application: 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 of the license.
Prepared by:
ao, City Planner
G:Planning/MISCELLABGabc Aqui
Submitted by:
~~J ~l___
David. W. Knapp, City Manager
76-1
Department of Alcoholic Beverage Control
AI'PLICATICN F'OR A,LCG]EI®LIC I3EVEF.AGE LICJENSE{~)
ABC 211 (6/99)
TO: Department of Alcoholic Beverage Control
100 Pasco de San Antonio
Rm. 119
San 3ose, CA 95113
(408)277-1200
DISTRICT SERVING LOCATION: SAN .TOSE
First Owner; OIVIINC
Name of Business: AQi7I CAL MEN
Location of Business:
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Type of license(s): 47
Transferor's license/name:
State of California
File Number: 480726
Receipt Number: 1731909
Geographical Code: 4303
Copies Mailed Date: September 1G, 2009
Issued Date:
1.0630 S DE AN7A BLVD
CUI'ERTINO, CA 95014-4450
SANTA CLARA
Yes
1079 LINCOLN A'L'E
SAN JOSE, CA 95125
License Tvne Transac ion Tvoe
47 ON-SALE GENERAL 1 ANNUAL FEE
Census Tract 5450.01
/ Dropping- Partner: Yes No
Fee Tvne Master Dun Date Fee
P40 Y 0 09/16/09 $847.00
Total $847.00
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 an attachment which shall be deemed part of this application.
Applicant agrees (a) that any "manager employed in an on-sale Iicensed 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: September 16, 2009
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 ire behalf; (2) that
he has read the foregoing and knows the contents thereof and that each of the above statements therein made are [rue: (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 satisfy the payment of a loan or, to fulfill an
agreemen! entered info 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) Utat the transfer application Wray
be wiUtdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s) Applicant Signature(s)
O M INC flee 211 Signature Pace
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State of,California
APPUCATlOE~ SfG~IATURE SI-~E~T ("S/GIV Olv'J
• This form is to be used as the signature page for
applications not signed in the District Office.
Read instrucfions on reverse before completing
• All signatures must be notarized in accordance
with taws of the State where signed.
2. FILE
TYPE
y `1 --Un ~.! e
~e+~ertZ~ ea-h~ng
Department of Alcoholic Beverage Control
Sole Owner
Partnership
~~Husband & Wife
Partnership-Ltd
Corporation
Limited Liability Company
Other
Original Person to Person Transfer
~Exchtmge . Premise to Premise Transfer
Other
i~, ll,d . .,Lf1G ,
6. APPLICANT'S MAlLWG ADDRESS (SIr9e1 addresslP.O. box, city, stela, zip code)
_IC'?q LlnLOjn ~-ye,,C,>`Gcn 70Se! Cf'~ gSlz`J
1. PREMISES ADDRESS (Street address, city, zip code) ~ --" -
I ~(>73D
P~
c~R7~~icariorv
Under penalty of perjury, 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 application, 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
icense(s) for which this application is made; (4) that the transfer
~~3LE OWNER
NAME (Last, first
~SOIy -
payment of a loan or to fulfill an agreement entered into more than
ninety (94) 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
it jure 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 Lo qualify for the license or withdraw
this application there will be a service charge ofone-fourth of the
Iit:ense fee paid, up to $104.
PARTNERSHIP/LIMITED pARTNERSHIF (Sigr«aturss of general partners only)
X
NAME
first
X
X
DATE SIGNED
CORPORATION
10. PRINTED NAME (Last, First, middle} SIG PATE SIGNED
('resident Vice Presidenf Chairman of the Board '
PRINTED NAME (Last, first, middle) SIG ~~ ,/ DATE SIGNED
TITLE
Secretary Asst. Secretary Chief Financial Officer Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run C~Yes ~lJo (Ef no,'complete Item #12 below)
12. NAME OF DESIGNATED MHNAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, lust mid18e)
ta. ~dEMeER'S
mIO01e)
first,
,I[ifitU
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ABC-211-SIG (2/03} "SIGN ON"
CAL~~~~~~~ ~9.~~.-~U~R®~~ L~C~CRI®WL~®6°a~~6~lT
State of California
County of ~~~~
On ~~- ~ ~ ~~~ before me, ~"~ ~R'~ i
~t` =-i ~ p~,~ l
personally appeared ~GtJVI~ ~ Y '(~~! ~
who 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/herltheir 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.
LESLIE Nu4GGETTI
Comm. Nc:1821793
~ NOTARYPUBLlC-CALIFORNIA ~ '
m &ANTACLAriA COUNTY
Nly Comm. Ezpket: Nov. 8, 2012
Place Notary Seal Ahove
I certify under PENALTY OF PERJURY under the Paws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS y ,nd an official seal. ~/
Signat
Sgnature of Not ry Public
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 Dohcu~ment Q~~/}
l-itle or Type of Document: ~~jl/!/~iG~~~`__"6' ` `
Document Date:
~~~~
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
^ Individual
^ Corporate Officer -Title(s): -
O Partner - ^ Limited ^ General
^ Attorney in Fact
^ Trustee
^ Guardian or Conservator
^ Other:
Signer Is Representing:
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~+
Number of Pages:
Signer's Name:
^ Individual
^ Corporate Officer -Title(s):
^ Partner - ^ Limited ^ General
^ Attorney in Fact
D Trustee
^ Guardian or Conservator
^ Other:
Signer Is Representing:
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®2007 National Notary Association • 9350 De Solo Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • wwaNeBoneMlotaryorg Item 85907 Reorder. CaA Td!-Free 1-800-876-6827
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