102-Alcohol Beverage License 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: 503502
100 PASEO DE SAN ANTONIO Receipt Number: 2018316
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: September 20, 2010
(408) 277- 1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE
First Owner: SCHALKER, DAVID WILLIAM
Name of Business: CUPERTINO VALERO
Location of Business:
County:
is Premise inside city limits?
Mailing Address:
(If different from
premises address)
Census Tract 5081.01
Type of license(s): 20
Transferor's license/name: 434211 / DEANZA USA GAS FAMILY Dropping Partner: Yes No
L-PSHIP
License Ty
pe _
ge Transaction E��e �Te Master pu2 Date Fee
NA STATE FINGERPRINTS NA N 1 09/20/10 $39.00
NA FEDERAL FINGERPRfNTS NA N 1 09/20/10 $24.00
20 - Off -Sale Beer And Wine PERSON -TO -PERSON TRANSFER NA y 0 09/20/10 $50.00
20 - Off -Sale Beer And Wine ANNUAL FEE NA y 0 09/20/10 $254.00
Total $367.00
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: September 20,2010
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 ofthe 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 all 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; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Narne(s) Appli'cant Signature(s)
SCHALKER, DAVID WILLIAM