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 File Number: 508052
100 PASEO DE SAN ANTONIO Receipt Number: 2040060
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: February 8, 2011
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE
First Owner:
Name of Business:
Location of Business:
County:
Is Premise inside city limits?
Mailing Address:
(If different from
premises address)
Type of license(s): 41
Transferor's license/name:
I
W11 11114 10 � #10011% �V 11 , 11
SANTA CLARA
Yes
Census Tract 5081.01
Dropping Partner
License Type Transaction Tye
yp—
EgLT e
yp
�aster
L
P_i2
Date
41 - On -Sale Beer And Wine ORIGINAL FEES
NA
y
0
02/08/11
41 - On -Sale Beer And Wine ANNUAL FEE
NA
Y
0
02/08/11
NA STATE FINGERPRINTS
NA
N
3
02/08/11
NA FEDERAL FINGERPRINTS
NA
N
3
02/08/11
Yes No
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.
Fee
$300.00
$350.00
$117,00
$72.00
$839.00
Applicant agrees (a) that any manager employed in an on -sale licensed premises will have all the qualifications of
a licensee, and (b) that lie 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: February 8, 2011
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 tinder 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; (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) Applic4lit YS . natu e(s)
7z
.SHEN YANG HOUSE INC
y