102-Department of Alcohol & 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 File Number: 502646
100 PASEO DE SAN ANTONIO Receipt Number: 2013542
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: Alligust 18, 2010
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE
First Owner:
FONTANAS ITALIAN INC
Name of Business:
FONTANAS ITALIAN RESTAURANT
Location of Business:
20840 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2121
County:
SANTA CLARA
Is Premise inside city limits?
Yes Census Tract
5077.01
Mailing Address:
(If different from
premises address)
Type of license(s): 47
Transferor's license/name: 384630
BELLOMONTE LLC Dropping Partner:
Yes— No
License Type Transaction Type
Fee Type Master Dup Pate
Fee
47 - On -Sale General Eating PERSON -TO -PERSON TRANSFER P40 y 0 08/18/10
$1,250.00
47 - On -Sale General Eating ANNUAL FEE
P40 y 0 08/18/10
$876.00
Total
$2,126.00
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 18, 2010
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 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 in ' lure 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) Applicant Signature(s)
.FONTANAS ITALIAN INC --See 211 Signature Page
State of California
APPLICATION SIGNATURE SHEET ("SIGN 0111'�
. . .. . ...... . ...
Department of Alcoholic Beverage Control
This form is to be used as the signature page for [:]soie owner []Corporation
applications not signed in the District Office.
Read instructions on reverse before completing. Partnership Ell-imited Liability Company
All signatures must be notarized in accordance D Husband & Wife Other
with laws of the State where signed. Partnership -Ltd
2, FILE NUMBER (if any) 3. LICENSE TYPE 4, TRANSACTION TYPE
[]Person to Person Transfer
Exchange []Premise to Premise Transfer
E]Other
---- — ------- —
6. APPLICANT'S MAILING ADDRESS (Street address/P.O. box, city, state, zip code)
T —PREMISES ADDRESS (Street address, city, zip code)
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) 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
license(s) for which this application is made; (4) that the transfer
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, (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)
CORPORATION 0;�
10. PRINTED NAME (Last, first, middle) SIGNATU �IE SIGNED
11 President E]Vice President []Chairman of the Board I /
PRINTED NAME (Last, first, mi de) SIG R DATE SIGN D
r,
TI LE
Secretary [-]Asst. Secretary [:]Chief Financial Officer [:]Asst. Treasurer
LIM TED LIABILITY COMPANY
11. The limited liability company is member -run E] Yes []No (if no, complete Item #12 below)
i. � — NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
ABC-21 1-SIG (2/03) "SIGN ON"