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06 Alcoholic Beverage Licenses ,~I~ __J --.., . City Hall 10300 Torre Avenue Cupertino, CA 95014 (408) 777-3212 Fax' (40&) 777-1166 I CUPEIUINO OFFICE OF THE CITY MANAGER SUMMARY AGENDA ITEM NUMBER (a (k AGENDA DATE June 20.2006 SUBJECT AND ISSUE Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application: Albertson's LLC 10425 De Anza Boulevard Grocery Store Off Sale General Person to person transfer 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: ~ David W. Knapp, City Manager G: IPlanningl.MISCELL IABC\abc albertsons.doc & 0... '- f Printed on Recycled Paper , Department of Alcoholic Beverage Control . APPLICA nON FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6/99) State of California TO: Department of Alcoholic Beverage 100 Paseo de San Antonio Room ]] 9 San Jose, CA 95] 13 (408) 277-]200 DISTRICT SERVING LOCATION: Control File Number: 440287 Receipt Number: 1566153 Geographical Code: 4393/f"") /I J. Copies Mailed Date: Lf i/ { tJ If Issued Date: First Owner: Name of Business: SAN JOSE ALBERTSONSLLC ALBERTSONS 7155 Location of Business: 10425 DE ANZA BLVD CUPERTINO, CA 95014 SANTA CLARA County: Is premise inside city limits? Mailing Address: (If different from premises address) Census Tract 5077.01 250 PARKCENTER BLVD BOISE, ID 83706 Type of Iicense(s): 21 Transferor's license/name: 356609 / ALBERTSONS IN( Dropping Partner: Yes No License Type Transaction Type Fee Type Master Dup Date Fee .... j t""'\J::'[:' (\ ~ , 1:' r!UJl.T'C'D A 1 !>5'P.5C\!I.r T0 ?E?_S0!,T '!'P.;.^..""1~_J:; 1\, A v n n<:!'l()I()~ <r 1 'l".~ ('In ,- ' .' , __ ___ _____ ___.__u__ 21 OFF-SALE GENERAL 30 TEMPORARY PERM! 21 OFF-SALE GENERAL ANNUAL FEE NA DUPLICATE NA STOCK TRANSFER MUL TlPLE NA y N Y o I o OS/20/06 OS/20/06 OS/20/06 Total $507.00 $100.00 $124.00 $2,005.00 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: May 20, 2006 Under penally of perjury, each person whose signature appears below, certifies and says: (I) He is an applicant, or one of the applicants, or an ex.ecutive 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 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 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 10 gain or establish a preference 10 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) ALBERTSONSLLC Applicant Signature(s) & II - J- State of California APPLICATION SIGNATURE SHEET (USIGN ON") Department of Alcoholic Beverage Control . This form is to be used as Ihe 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 (rt any) 3. LICENSE TYPE Type 21 & 59 1. OIMllERSHIP TYPE (Ch8d< onel B Sole Owner Partnership o Husband & Wife D Partnership-Ltd 4. TRIINSACTION WPE D Corporation o Limited Liability Company D Other o Original o Exchange [2] Person to Person Transfer o Premise to Premise Transfer o Other 24071.2 LLC membership interest 5. APPlICANT[S) NAME (Last, firsL middle) Albertson's LLC (flea Albertson's, Inc. before statutory conversion under Section 226 of Delaware Gelleral Corporation Law) 6. APPLICANT'S MAILING ADDRESS (Stteet addtessJP.O. box. city, stale, zip code) 250 Parkcenter Boulevard, Boise, Idaho 83706 7. PREMISES ADDRESS (SIrem address, city, Zip code) See Attached List of Locations APPLICANT'S CERTIFICA TlON Under penalty of peIjury, 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 aP2lication, duly authorized tQ make this application on its behalf; 2) that he/she has read the foregoing and knows the contents t ereof 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 SQLE OWNE;R 8. PRINTED NAME (Lest, first, middle) ~GNATURE J DATE SIGNED PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) payment of a loan or to fulfill an agreement entered into more than ninety (90) daxs preceding the day on which the transfer application is filed with the Department, (b) to s:ain or establish a pr~ference to o~ for any creditor or transferor, or (c) to defi:aud or Injure any credllor or transferor; (5) that the transfer apphcation may be withdrawn by either the applicant or the licensee with no resulting liability to tbe Department. I understand that if! fail to qualify for tbe license or withdraw this application there will be a servIce cliarge of one-fourth of the hcense fee paid, up to $100, 9. PARTNER'S PRINTED NAME (l8st, firsl, middle) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME (l.est, first, middle) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME (l.8st, first, midlIe) SIGNATURE DATE SIGNED X CORPORATION 10. PRINTED NAME (test, fi",~ mkIdIe) I ~GNATURE DATE SIGNED TITLE o President D Vice President PRINTED NAME (l8SL first, middle) o Chairman of the Board I SIGNATURE X. TITLE DATE SIGNED o Secretary D Asst. Secretary 0 Chief Financial Officer 0 Af.5t. Treasurer LIMITED LIABILITY COMPANY 11. The limited liability company is member-run 0 Yes 0 No 12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lest, firsL middle) Albertson's Holdings LLC MEMBER'S PRINTED NAME (lest, fi (If no, complete Item #12 below) ! ABC INITIALSIDATE (ABC lJS8 Dliy) DATE SIGNED {/o- b DATE ~NED 6!1f (eb , I . 5/1.5/0{;, ~a.. -] State of Califomia APPLICATION SIGNATURE SHEET (reverse) Department of Alcoholic Beverage Control I FILE NUMBER APPLICANT'S CERT/FICA TION Under p~nalty of perjury, each perspn whose .signature appears p~yment ofa loan or to .fulfill an agreement entered into more than below, c.erllfies and says: (I) He/She IS an apphc~nt, or one of nme~y (~O) ~ays prec~dmg the day on which the tr~nsfer the apph.cants. or an. execul1ve o~ficer of ~he !IPphcam. apphcatlOn IS filed With the .Department, (b) to gam or establish a corporatlO~, nam~d I~ the fC!regomg ap~hcatJon, duly authOrized pr~ference to o~ for any creditor or transferor, or tc) to defraud or to make t~IS applicatIOn on ItS behalf; ) that he/she has read Injure any' creditor or tr!,nsferor; (5) !hat the transter application the foregomg and knows the contents t ereof and that each of the may be Withdrawn by either the apphcant or the licensee with no above statem~nts therein 'Pade are true; (3) that nl? pc:rson .other resulting liability to. the I?epartm~nl. than the applIcant or al'phcants has any dlfl~ct or indirect mterest I unaerstand that If] faJlto quahfy for the license or withdraw this in the applicant or applicant's business to be conducted under the application there will be a servIce charge of one-fourth of the license(~) for which this application is made; (4) that the transfer hcense fee paid, up to $100. application or proposed transfer is not made to (a) satisfy the Premises Address (Item #7) - Enter the location of the premises for which the license is applied. Partnerships (Item #9) - The application must be signed by each of the partners (e.g., general partnerships, husband and wife, etc.). Limited Partnerships - The application must be signed by each of the general partners, Limited partners do not need to sign. Corporations (Item #IO) - The application must be signed by two officers of the corporation, one from each of the following categories: (a) The chairperson of the board, the president, or a vice president; and (b) the secretary, assistant secretary, chief financial officer, or assistant treasurer. Limited Liability Companies (Item #13) - For a limited liability company that is managed by its members, the application must be signed by each member or by an officer authorized by the articles of organization or the operating agreement to bind the company. For a limited liability company that is managed by a manager or managers, the application must. by signed by the manager or managers or by an officer authorized by the articles of organization or the operating agreement to bind the company. ..' "SIGN ON" 14. PRINTED NAME (Las~ hI, middle) Miller, Robert Gerald (Manager/CEO of Applicant) X PRINTED NAME (Lasl, fil"$l, middle) Navarro, Richard John (Manager/CEO of Applicant) PRINTED NAME (Las~ fil"$l, middle) "........... ,I' ~AR '" "..".t C~ ". PRINTED NAME (Last, first, rriddle)....ooc ,,' ...-...... ,." "'. .. ~ " '-+ ~ ~~ .. ",,-=- = . ~ , , . . . PRINrED NAME (Lest, ftrs~ 1I'lid<IJ) - .. .. .. .. D[)U~JT~!""1 "14"11= ~~__9<<"t fi...;t. rni.rt+} PRINTED NAME (Lest, firs~ middle) PRINTED NAME (Las\' fiJS~ middle) SIGNATURE ~ X PRINTED NAME (Lasl, firs~ middle) SIGNATURE x INSTRUCTIONS AND GENERAL INFORMATION . Type or print clearly in black or blue ink (do not use red). . If you need more space for signatures, use Item #14. Ownership Type (Item #1) - Check the box for the type of ownership for the business. FUe Number (Item #2) - If this is an application for a transfer or exchange, enter the number assigned to the specific license being transferred or exchanged. License Type (Item #3) - Enter the numeric designation for the license (e.g., Type 21) or description (e.g., Off-Sale General). Transaction Type (Item #4) - Check the box for the type of transaction, Applican t(s) Name (Item #5) - Enter the name of the applicant. For a general partnership, the names ofthe individual partners, For a limited partnership, limited Hability company, or a corporation, the name of the enti ty. Applicant's Mailing Address (Item #6) - Enter the address where you wish to receive mail. May be different from the premises address. Business and mailing addresses are public information and are availabl.e to the public. Please consider this, especially when listing a mailing address. ABC-211-SIG (2/03) 5 DATE SIGNED ~ (.z-./ 0 DATE SIGNED DATE SIGNED DATE SIGNED DATE SIGNED . DATE SIGNED I DATE SIGNED DATE SIGNED DATE SIGNED &q-y Department of Alcoholic Beverage Control 'APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE{S) ABC 21 I (6/99) State of California TO: Department of Alcoholic Beverage 100 Pas eo de San Antonio Room 119 San Jose, CA 95 I 13 (408) 277-1200 DISTRlcr SERVING LOCATION: Control File Number: 440287 Receipt Number: 1566153 Geographical Code: 4393/<'"'1 /J J, Copies Mailed Date: U i/ { tI 'f Issued Date: First Owner: Name of Business: SAN JOSE ALBERTSONS LLC ALBERTSONS 7155 Location of Business: 10425 DE ANZA BLVD CUPERTINO, CA 95014 SANTA CLARA County: Is premise inside city limits? Mailing Address: (If different from premises address) Census Tract 5077.01 250 PARK CENTER BLVD BOISE, ID 83706 Type of licensees): 21 Transferor's license/name: 356609 / ALBERTSONS IN( Dropping Partner: Yes No License Type Transaction Type Fee Type Master Dup Date Fee '" ,:,~p- ~_,\..~~ .QE!,c~~R/\.L PEP,,-S0.~~ T0 PEP.5'0~.T ,,!,p_ ^_""J~.~ ~~l~ v f) f\CI'1(\/()jC. ot 1 '1'7 A f)(' -- . . . .... --.......... ........ ..... -,--, .....- 21 OFF-SALE GENERAL ANNUAL FEE NA Y 0 OS/20/06 $507.00 30 TEMPORARY PERMI DUPLICATE NA N ] OS/20/06 $100.00 21 OFF-SALE GENERAL STOCK TRANSFER MULTIPLE NA Y 0 OS/20/06 $124.00 Total $2,005.00 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 Ihe above queslions on an allachment which shall be deemed pari 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 20, 2006 Under penalty of perjury. 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 applicanl corporation. named in the foregoing applicalion. 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 statemenls therein made are true; (3) thai no person other than the applicant or applicants has any direct or indirect inlerest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; (4) tllat the transfer application or proposed transfer is n01 made to satisfy the payment of a loan or to fulfill an agreement entered inlo more than ninety (90) days preceding the day on which the transfer applicalion is filed with the DeparLmenl or to gain or establish a preference to or for any creditor or transferor or to defraud or injure any creditor of Iransferor; (5) Ihat the transfer application may be withdrawn by either the applicant or the licensee willi no resulling liability to the DeparlmenL Applicant Name(s) ALBERTSONS LLC Applicant Signature(s) ~ a.-S- State of California APPLICATION SIGNATURE SHEET ("SIGN ON") Department of Alcoholic Beverage Control . This fonn 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 ortha State where signed. 2. FILE NUMBER (it any) 3. LICENSE TYPE 1. Ov.NERSHIP TYPE (Check one) B Sole Owner Partnership o Husband & Wife o Partnership-Ltd o Corporation 1ZI Limited Liability Company o Other 4. TRANSACTION WPE Type 21 & 59 o Original o Exchange I2l Person to Person Transfer o Premise to Premise Transfer o Other 24071.2 LLC membership interest 5. APPLlCANT(S) NAME (las~ ftrs~ middtol Albertson's LLC (flea Albertson's, Inc. before statutory conversion under Section 226 of Delaware Geileral Corporation Law) G. APPLICANT'S MAILING ADDRESS (Streel address/P.O. box, dly. slalE!. ~p code) 250 Parkcenter Boulevard, Boise, Idaho 83706 7. PREMISES ADDRESS CSnet addreSs, ciIy, ~p code) See Attached List of Locations APPLICANT'S CERTlFICA TlON Under penalty afperjury, each persan whase signature appears belaw, certifies and says: (I) He/She is an applicant, or ane af the applicants, ar an executive afficer af the applicant corparatian, named in the foregaing aPElicatian, duly autharized to. make this applicatian an its behalf; (2) that he/she has read the faregaing and knaws the contents thereof and that each of the above statements therein made are true; (3) that no persan ather than the applicant ar aJlplicants has any duect ar indirect interest in the applicant or applicant's business to. be canducted under the license(~) far which tllis application is made; (4) that the transfer applicatian ar prapased transfer is not made to (a) satisfy the $;Q.LE OW"'ER payment ofa loan ar to. fulfill an agreement entered into more than ninety (90) da)fs preceding the day an which the transfer applicatian is filed with tlie Department, (b) 10. gain ar establish a pr~ference to. a~ far any creditor ar transferor, ar (c) to. defraud ar lDJure any' creditor or transferar; (5) that the transfer appllcatian may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. I understand that ifI fail to qualify far the license or withdraw this application there will be a servICe cnarge af ane- fourth of the license fee paid, up to $100. B. PRINTED NAME (Les~ first, middle) SIGNATURE DATE SIGNED X PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) 9. PARTNER'S PRINTED NAME (Last. first midde) SIGNATURE DATE SIGNED X . PARTNER'S PRINTED NAME (LBsl, fir$!. middle) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME (Lest, first, mlddlel SIGNATURE DArE SIGNED X CORPORATION 10. PRINTED NAME (Lasl, firat, middle) I ~GNATURE DATE SIGNED TITLE o President 0 Vice President 0 Chairman of the Board PRINTED NAME (La5t firs~ middle) SIGNATURE DATE SIGNED X TITLE o Secretary 0 Asst. Secretary D Chief Financial Officer 0 A~5t. Treasurer LIMITED LIABILITY COMPANY 11. The limited liability company is member-run 0 Yes [2] No 12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, firs~ middle) (If no, complete Item #12 below) ! AIlC INITIALSIOATE (ABC use only) DATE SIGNED /" (0- f, 6li~DrDb J , Albertson's Holdings LLC MEMBER'S PRINTED NAME (Las\. ft . 5/15Ib~ ~ a-~ T7_'I..\1 . State of California APPLICATION SIGNATURE SHEET (reverse) Department of Alcoholic Beverage Control I FilE NUMBER APPLICANT'S CERTlFICA nON Under p~nalty of perjury, each perspn whose .signature appears p~yment of a Joan or to .fulfill an agreement entered into more than below, c,erl1fies and says: 0) HelShe IS an apphc~nt, or one of mne!y (~O) ~ays prec~dmg the day on which the tr!lnsfer the apphcants, or an executIVe officer of the apphcam apphcatlon IS filed WIth tfie Department, (b) to gam or establish a corporatiol), nam~d i~ the fC!regoing app-Iication, duly authorized pr~ference to o~ for any creditor or transferor, or (c) to defraud or to make thIS application on Its behalf; (2) that helshe has read lO;ure 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] fail to qualify for the license or withdraw this in the applicant or applicant's business to be conducted under the application there will be a servIce charge of one. fourth of the Iicense(s) for which this application is made; (4) that the transfer hcense fee paid, up to $100. application or proposed transfer is not made to (a) satisfy the Premises Address (Item #7) - Enter the location of the premises for which the license is applied. Partnerships (Item #9) - The application must be signed by each of the partners (e.g., general partnerships, husband and wife, etc.). Limited Partnerships - The application must be signed by each of the general partners. Limited partners do not need to sign. Corporations (Item #10) - The application must be signed by two officers of the corporation, one from each of the following categories: (a) The chairperson of the board, the president, or a vice president; and (b) the secretary, assistant secretary, chief financial officer, or assistant treasurer. Limited Liability Companies (ltem#13)- Fora limited liability company that is managed by its members, the application must be signed by each member or by an officer authorized by the articles of organization or the operating agreement to bind the company. For a limited liability company that is managed by a manager or managers, the application must by signed by the manager or managers or by an officer authorized by the articles of organization or the operating agreement to bind the company. ,,' "SIGN ON" 14. PRINTED NAME (las~ first, middle) Miller, Robert Gerald (Manager/CEO of Applicant) X PRINTED NAME (las~ firsl, middle) Navarro, Richard John (Manager/CEO of Applicant) PRINTED NAME (last. first, middle) . . . PRINTED NAME (Lest, firs~ . DP"."TC:f\ "'I~..~C {J. .op,t ~",I, ~.r:Lo:'I:J'!J PRINTED NAME (last. filSl. middle) (!; SIGtM.TURE .- 1 ....c.\\ X !\_ -or SIGNATURE PRINTED NAME (last, fi",~ middle) 5--1 ~4-~ X PRINTED NAME (lest. fi",~ middle) SIGNATURE X INSTRUCTIONS AND GENERAL INFORMATION . Type or print clearly in black or blue ink (do not use red). . !fyou need more space for signatures, use Item #14. OW" ership Type (Item #1) - Check the box for the type of ownership for the business. File Number (Item #2) - If this is an application for a transfer or exchange, enter the number assigned to the specific license being transferred or exchanged. License Type (Item #3) - Enter the numeric designation for the license (e.g., Type 21) or description (e.g., Off.Sale General). Transaction Type (Item #4) - Check the box for the type of transaction. Applicant(s} Name (Item #5) - Enter the name of the applicant. For a general partnership, the names of the individual partners. For a limited partnership, limited ijability company, or a corporation, the name cfthe entity. Applican t 's Mailing A ddress (Item #6) - Enter the address where you wish to receive mail. May be different from the premises address. Business and mailing addresses are public infonnation and are available to the public. Please consider this, especially when listing a mailing address. ABC-211-SIG (2/03) '5 DATE SIGNED DATE SIGNED OATESIGNED DATE SIGNED OATE SIGNEO DArE SIGNED DATE SIGNED DATE SIGNED DATE SIGNED ~rA-7 /:\1 !i.~/~ __=-__J . City Hall 10300 Torre Avenue Cupertino, CA 95014 (408) 777-3212 F"y. ".:in!!) 777_"'-1....... F CUPEIUINO OFFICE OF THE CITY MANAGER SUMMARY AGENDA ITEM NUMBER (0 b AGENDA DATE June 20. 2006 SUBJECT AND ISSUE Application for Alcoholic Beverage License. BACKGROUND 1. Name of Business: Location: Type of Business: Type of License: Reason for Application: Chuck E. Cheese 786 19805 Stevens Creek Boulevard Restaurant On-Sale Beer and Wine for Bona Fide Public Eating Place (41) New Restaurant 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: ~ ~ Ciddy Wordell David W. Knapp, City Manager G: IPlanninglMISCELL IABC\abc alber/sons. doc ~lr-( Pdnted on Recycled Paper Departmtnt of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6/99) TO: Department of Alcoholic Beverage Control File Number: 441291 100 Pas eo de San Antonio Receipt Number: 1568925 Room 119 Geographical Code: 4303 San Jose, CA 95113 Copies Mailed Date: June 9, 2006 (408) 277-1200 Issued Date: DISTRICT SERVING LOCATION: SAN JOSE First Owner: CEC ENTERTAINMENT INC Name of Business: CHUCK E CHEESE 786 Location of Business: 19805 STEVENS CREEK BLVD CUPERTINO, CA 95014 SANTA CLARA Yes Census Tract 5081.01 County: Is premise inside city limits? Mailing Address: (If different from premises address) 4441 W AIRPORT FWY IRVING, TX 75062 Type of license(s): 41 Transferor's license/name: / Dropping Partner: Yes No License Type Transaction Type Fee Type Master Dup Date Fee 41 ON-SALE BEER AND ORIGINAL FEES NA y 0 o 6/I:J91 U () jijO(i:UO 4] ON-SALE BEER AND ANNUAL FEE NA Y 0 06/09/06 $304.00 Total $604.00 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: June 9, 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 than the applicant or applicants has any direct or indirect interesl 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 agreement entered into more than ninety (90) days preceding the day on which the transfer application is filed with the Department or 10 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) CEC ENTERTAINMENT INC Applicant Signature(s) Sf'f' 211 Sienatllre Paef' ~b-L " State of California APPLICATION SIGNATURE SHEET t'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 (Check one) o Sole Owner o Partnership o Husband & Wife o Partnership-Ltd [2] Corporation o Limited Liability Company o Other 3. LICENSE TYPE 4. TRANSACTION TYPE 2 FI LE NUMBER (if any) 4] [2] Original o Exchange o Person to Person Transfer o Premise to Premise Transfer D Other 5 APPLlCANT(S) NAME (Lasl, firsl, middle) CEC ENTERTAINMENT, INC. 6. APPLICANT'S MAILING ADDRESS (SIreet addresslP.D. box, cily, slate, zip code) 4441 WEST AIRPORT FREEWAY, IRVING, TX 75062 7. PREMISES ADDRESS (Street address, cily, zip code) 19805 STEVENS CREEK BLVD., CUPERTINO, CA 95014 APPLICANT'S CERTlFICA nON Under penalty of perjury, each person whose signature appears below, certifies and says: (I) He/She is an applicant, or one of .he 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 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 ~. f'KINH::UNAMt>(l.aSl, ,,,sl, mlddlel SIGNATURE payment of a loan or to fulfill an agreement entered into more than ninety (90) da}'s 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 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. J understand that if I fail to qualify for the license or withdraw this application there will be a servtce charge of one-fourth of the hcense fee paid, up to $100. DATE StGNED X PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) 9 PARTNER'S PRINTED NAME (Lasl, first, middle) SIGNATURE DATE SIGNED X --~- PARTNER'S PRI NTED NAM E (Lasl, first, middle) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME {Lasl, fi(st, mlddlel SIGNATURE DATE SIGNEO X ORPORATION >J \ 7 1 D. PRINTED NAME (Lasl, Ilrst, middle) V MICHAEL MAGUSIAK TITLE o President 0 Vice President ;\)A 7 PRINTED NAME (Lasl, firsl, middle) ~V ALICE WINTERS TITLE DATE SIGNED DATE SIGNED .p; ,:)000 , D Secretary [2] Asst. Secretary D Chief Financial Officer [Z] Asst. Treasurer LIMITED LIABILITY COMPANY 11. The limited liability company is membeHun 0 Yes 0 No 12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lasl, lirst, middle) 13. MEMBER'S PRINTED NAME (Last. firsl, middle) SIGNATURE X MEMBER'S PRINTED NAME (Lasl. tirsl. middle) SIGNATURE X 3) ,..r.:;," S I G LSt, P J{ .l&/h (If no, complete Item #12 below) ABC INITIALS/DATE (ABC use only) DATE SIGNED - DATE SIGNED ON" ~b-j STATE OF TEXAS, COUNTY OF DALLAS, ss: I hereby certify on this fI tL said County and State, pel'S Michael H. Magusiak, President and Alice Winters, Assistant Secretary and Assistant Treasurer who are personally lrnown to me to be said officers orCEe ENTERTAINMENT, INC., a Kansas Corporation, who executed the foregoing as such officers and acknowledged to me they executed the same. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my seal the day and veal' last above written. _. /J _. _ . .. _.. _ 1 _ . \ _ '" . . ... . _ . -- -.-----, 0."_ ."",,,- _,,_,_~"",C","',., -,...",. -.-., '9\t~.,U':" lZ/;;;.;.j..A~:::'~N~t~ryP~l biic' My Commission Expires: 7/12/07 ,;.~\IIUr~" ~...~",-;.'P"i' HI.i. I, P/'''',\\ RITA D. WINKLER \).'*:":'; ,1 Notary Public. Sraleof Texas .,<.,,;-;~..., My COmmission Exp_ 07.12.2007 ""II"" ~ h~L( . Department of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6/99) TO: Department of Alcoholic Beverage Control File Number: 441291 100 Paseo de San Antonio Receipt Number: 1568925 Room 119 Geographical Code: 4303 San Jose, CA 95113 Copies Mailed Date: June 9, 2006 (408) 277-1200 Issued Date: DISTRICT SERVING LOCATION: SAN.J.QS.E. Fi rst Owner: CEC ENTERTAINMENT INC Name of Business: CHUCK E CHEESE 786 Location of Business: 19805 STEVENS CREEK BLVD CUPERTINO, CA 95014 SANTA CLARA Yes Census Tract 5081.01 County: Is premise inside city limits? Mailing Address: (If different from premises address) 4441 W AIRPORT FWY IRVING, TX 75062 Type of license(s): 41 Transferor's license/name: / Dropping Partner: Yes No License Type Transaction Type Fee Type Master Dup Date Fee 41 ON-SALE BEER AND ORIGINAL FEES NA y U u6(()~itJo :)l30u:(jIJ 4] ON-SALE BEER AND ANNUALFBE NA Y 0 06/09/06 $304.00 Total $604.00 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: June 9,2006 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 orficer 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 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 this application is made; (4) that the transfer application or proposed transfer is not made to satisfy the paymenl of a loan or to fulfill an agreement entered illto 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 Deparlment. Applicant Name(s) CEC ENTERTAINMENT INC Applicant Signature(s) S"" 211 Sigmltllre Page ~b-) 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 O'MllERSHIP TYPE (Check one) o Sole Owner D Partnership o Husband & Wife o Partnership-Ltd (2] Corporation o Limited Liability Company o Other 2 FILE NUMBER (If eny) 3. LICENSE TYPE 4. TRANSACTION TYPE 4J [2] Original o Exchange o Person to Person Transfer o Premise to Premise Transfer o Other 5 APPLlCANT{SI NAME (La.t, firsl, middle) CEC ENTERTAINMENT, INC. 6. APPLICANT'S MAILING ADDRESS (Street address/PO box. ciW, stale. zip code) 4441 WEST AIRPORT FREEW A Y, fRVING, TX 75062 7. PREMISES ADORESS (Slreeladdress. dly. zip code) 19805 STEVENS CREEK BLVD., CUPERTINO, CA 95014 APPLICANT'S CERTlFICA TlON Under penalty of perjury, each person whose signature appears be low, 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 apQlication, 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 01' applicants has any direct 01' indirect interest in the applicant or applicant's business to be conducted under the licensers) for which this application is made; (4) that the transfer application or proposed transfer is not made to (a) satisfy the SOLE OWNER H. I-'kiNIl:lJNAMl:[LaSI,II'sl, m'OdleJ SIGNATURE 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 Departmen~ (b) to gain or establish a preference to or for any creditor or tranSferor, or (c) to defraud or Injure 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. J understand that if [ fail to CJualify for the license or withdraw this application there will be a service charge of one -fourth of the lIcense fee paid, up to $100. -' -.- .- -"~-' -,- .:.-., ' .- _c '.,- . ", . ,.-, -, ... " -- ~ ,,- DATE SIGNED X PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) 9. PARTNER'S PRINTED NAME (Lasl, first, miOdle) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME (Last, first, midale) SIGNATURE DATE SIGNED X PARTNER'S PRINTED NAME (Last. first, middle) SIGNATURE DATE SIGNED X ORPORATION II 17 10. PRINTED NAME (Last, first. middle) 'V MICHAEL MAGUSIAK TITLE o President 0 Vice President ;\) A 7 PRINTED NAME (Last, first. miadle) ~V ALICE WINTERS DATE SIGNED o Chairman of the Board SIGNATURE X a&:.v TITLE DATE SIGNED 0100 b ? D Secretary [{] Asst. Secretary D Chief Financial Officer [{J Asst. Treasurer __,,__ .,..~.. '__.~~L~____ LIMITED LIABILITY COMPANY 11. The limited liability company is member-run 0 Yes 0 No 12 NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lasl, fllSt, middle) 13 MEMBER'S PRI NTED NAME (Last. firs!. middle) SIGNATURE X MEMBER'S PRINTED NAME (Lasl, flfSt, middle) SIGNATURE X 3) A. "SIG LS'(> P Jf . l&/h (If no, complete Item #12 below) ABC I NITIAlS/OA TE (ABC use onfy) DATE SIGNED DATE SIGNED ON" ~b-& , STATE OF TEXAS, COUNTY OF DALLAS, ss: I hereby certifY on this g1L. ,2006, before me a Notary Public in and for said County and State, pefs ally a peared: Michael H. Magusiak, President and Alice Winters, Assistant Secretary and Assistant Treasurer who are personally known to me to be said officers of CEC ENTERTAINMENT, INC., a Kansas Corporation, who executed the foregoing as such officers and acknowledged to me they executed the same. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my seal the day and year last above written. rJ'J . LJ ' _) \ ~~ . ~~.-- Notary Public My Commission Expires: 7/12/07 I\IIIU"... ............ JIo.P"- ""<.1."1' f~~"""'\\ RITA D. WINKLER rJ:"~': ~ j Notary Public, State ot Texas ,.,.'::-ji';'~/ My COmmission Exp. 07-12-2007 "n.p\1 ~0~1