102-Application for Alcoholic Beverage License.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
DISTRICT SERVING LOCATION
First Owner:
Name of Business:
Location of Business:
File Number: 506824
Receipt Number: 2033802
Geographical Code: 4303
Copies Mailed Date: December 22, 2010
Issued Date:
SAN JOSE
KIM, EUNHEE LEE
KONG TOFU & BBQ
19626 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2465
County: SANTA CLARA
Is Premise inside city limits? Yes
Mailing Address:
(If different from
premises address)
Type of license(s): 41
Transferor's license/name: 435548 / PACIFIC RESTAURANT
GROUPLC
Census Tract 5080.01
Dropping Partner: Yes_ No
Licenselype Transaction Type
_p
Fee Type
Master
Dun
Pate
Fee
41 - On -Sale Beer And Wine PERSON -TO -PERSON TRANSFER
NA
y
0
12/22/10
$150.00
41 - On -Sale Beer And Wine ANNUAL FEE
NA
y
0
12/22/10
$350.00
NA STATE FINGERPRINTS
NA
N
2
12/22/10
$78.00
NA ISSUE TEMPORARY PERMIT
NA
y
0
12/22/10
$100.00
NA FEDERAL FINGERPRINTS
NA
N
2
12/22/10
$48.00
Total $726.00
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: December 22, 2010
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 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 deftaud 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) Applicant Signature(s)
KIM, EUNHEE LEE See 211 Signature Page
KIM. JOODONG It k�
State of California
APPLICATION SIGNATURE SHEET (""SIGN ON")
Department of Alcoholic Beverayz Control
This form is to be used as the signature page for
applications not signed in the District Office.
All signatures must be notarized in accordance
with laws of the State where signed.
[:] sole owner
,gPartnership
10-lusband & Wife
Partnership -Ltd
11 Corporation
DLimited Liability Company
1-1 Other
2, FILE NUMBER (if any) 3. LICENSE TYPE 4. 1 RAMAU I IUN I YFI:
]Original person to Person Transfer
FlExchange []Premise to Premise Transfer
[]Other
(Last, first, middle)
k T VA P Teo -- D" t &K eA kT61, tip het L
6 APPLICANT'S MAILING ADDRESS (Street'dddress/P.O. box, city, state, zip code)
e; R9 0 FoJeL MeSek Dv-. Sam CA qt;-I;�3
SES ADDRESS (Street address, city, zip code)
q 626 _!�twehq CveeL- t� I wi - CovvcFm o , CA q 15, o 14
APPLICANT'S CERTIFICATION
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,
SOLE OWNER
8. PRINTED NAME /I ast, first middle) SIGNATURE DATE SIGNED
X
X
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
ElPresident VicePresident[]chairman of the Board
190110111114
Secretary E]Asst. Secretary E]Chief Financial Officer E]Asst. Treasurer,
"Ma
11. The limited liability company is member -run E]Yes D No (If no, complete Item #12 below)
_1Z.-NAME -OF —DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
13. MEMBER's PRINTED NAME (Last, first, middle)
X
MEMB_E_F_VS PRINTED -NAME (Last, -first, -middle)------ SIGNATURE DATE SIGNED
X
ABC-21 I -SIG (2/03) "SIGN ON"