102-Department of Alcoholic Beverage Control Application.pdfDepartment of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
TO: Department of Alcoholic Beverage Control
100 PASEO DE SAN ANTONIO
ROOM 119
SAN JOSE, CA 95113
(408) 277-1200
First Owner:
Name of Business:
Location of Business:
County:
Is Premise inside city limits?
File Number: 502523
Receipt Number: 2013021
Geographical Code: 4303
Copies Mailed Date: August 13, 2010
Issued Date:
61111110"Olf'"14"FA311 X1411=11 1I1TA01101611111"a
SHANGHAI RESTAURANT
10877 N WOLFE RD
CUPERTINO, CA 95014-0614
SANTA CLARA
Yes
Mailing Address: 1075 SPACE PARK WY
(If different from #297
premises address) MOUNTAIN VIEW, CA 94043
Type of license(s): 41
Transferor's license/name: 433707 / HUCHIANG DUMPLING
HOUSE CORP
Census Tract 5081.01
Dropping Partner: Yes NO7zX
LicDjaLIM Transaction Type FeeTe Master pun pate
Fee
NA STATE FINGERPRINTS NA N 2 08/13/10
$78.00
NA FEDERAL FINGERPRINTS NA N 2 08/13/10
$48.00
41 - On -Sale Beer And Wine PERSON -TO -PERSON TRANSFER NA y 0 08/13/10
$150.00
41 - Oil -Sale Beer And Wine ANNUAL FEE NA y 0 08/13/10
$350.00
Total
$626.00
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 premises 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: August 13, 2010
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is all 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 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 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 or transferor or to defraud or injure any
creditor of transferor; (S) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s) Applicant Signature(s)
.SHANGHAI RESTAURANT INC See 211 Signature Page
State of California
APPLICATION SIGNATURE SHEET ("SIGN ON"'
Department of Alcoholic Beverage Control
This form Is to be used as the signature page for E]soia owner ❑Partnership -Ltd
applications not signed In the District Office.
Read Instructions on reverse before completing. E]Partnership *Corporation
All signatures must be notarized in accordance []marrled Couple OLimited Liability Company
with laws of the State where signed. DDomestic Partner []Other
FILE NUMBER (if any) 3. LICENSE TYPE
433707 41
APPLICANT(S) NAME (Lost, first nVddle)
Shanghai Restaurant Inc
6, APPLICANTS MAILING ADDRESS (Street addressJP.O. box, city, state, Ap code)
0,
10877 Wolfe Rd., Cupertino, CA 95014
[]Original
[]Exchange,
APPLICANT'S CERTIFICA
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) lie/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
ficense(s) for which this application is made; (4) that the transfer
SOLE OWNER
8. PRINTED NAME (Last, first, middle)
[V Person to Person Transfer
OPremise to Promise Transfer
0Other
payment of a lonn 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 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.
I understand that if I fail to qualify for the license or withdraw
this application there will be a service charge of one-fourth of the
license fee paid, up to $ 100,
PARTNERSHIPILIMITED PARTNERSHIP (Signatures of general partners only)
X
PARTNER'S P - RINTED NAME (Last, first, middle) SIGNATURE DATE SIGNED
X
PARTNERS PRINTED NAME (Last, fist, middle) SIGNATURE DATE SIGNED
X
CORPORATION
first, middle) iGN 7
T6 --Owl A V�UaATfiff fir, X 7E DATE
Yu, Feng Hua
TITLE
President E]vice President Chairman of the Board
PRINTED NAME (Last, first, middle) aNWTtjRE
[]AS'st.secfetary [—Chief Financial Officer _UAsst. Treasurer
11. The limited liability company Is member -run Dye$ No (if no, complete Item #12 below)
MANAGING MEMBER OR DESIGNATED OFF first, middle)
-1-310-EARBER'S PRINTED NAME Last-,fii-s"t, _rWd_dIo)___
ED
91
ABC-21 I -SIG (2/09) "SIGN ON"
State of California
County of
On y — 1-31 /fore me, �/
(Here insert name and title of the
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/her/their authorized
capacity(ics), and that by his/her/their signature(s) on the instrument the pers.on(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
PAMELA R. DILLON
C 0� L mmlsslo �Dl 10M N C M'sao
Commission M187�6732
WITNE,S S hand and official seal. otary PU lic Calif rnla
Notary Public - California
S Solita Clara Cou�ty
anta Clara County
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as
0
M Comm. Ex Irn Jan'l 2, 201 A4
Signature of Notary Public (MNotaryy Seal
DES ON OF THE ATTACHED DOCUXI�NT
9
(Title or description of attached document)
(Title or description of attached document continue
Number of Pages — Document Date
(Additional information)
CAPACITY CLAWED BY THE SIGNER
0 Individual (s)
(Title)
1:1 Parmer(s)
0 Attomey-in-Fact
EJ Trustee(s)
0 Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
prop
erly completed and attached to that document. The only exception is if a
document is to be recorded outside of California- In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her namc,— it appears within his or her
. commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/they,- is /are) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
Impression must not cover text or lines. If sea] impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
Signature of the notary public must match the signature on file with the office of
the county clerk
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
Securely attach this document to the signed document
2008 Version CAPAvl2.10.07 800-873-9865 www.NotaayC]asses.com