103-Cupertino Senior Center Coordinating Council application.pdf i
p c NNW
OFFICE OF THE CITY CLERK D
DEC 2
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-32 SCLIPERTINO CITY CLERK TELEPHONE: (408)777-3223• FAX: (408) 777-3366 '..
CUPERTINO
APPLICATION FOR BINGO PERMIT
1. Name of Organization ! L�ff7dIP7 µt y)fO/ C�13 ( t^nerlii�ci�c WC �7f;,
Name of Officers
Address of Officers mar a� kr <
2. Days of operation M Do, — FR)I , Hours of Operation y�
3. Address of Bingo game ' J�,i J Seri ;/t „7 S (',reek - C?l PA qj Cal q
4. Purpose of premises used by organization 7iy I JzP
5. Ownership of Bingo equipment CT_,;n}-Lylb sc.nim cee),L' '
6. Name of person responsible for operation of Bingo game AMrinC (I Pidl/(>r
7. Name of everyone who has any fmancial interest in Bingo game
8. Na of contact (! i v o
Address of contact ISS9I o
Phone & email of contactppg S Y)j �Yka I Llp�t Vt�Ss 1
seoie') C'-'()+e,r efyW 1 (VA Nooe, `J` ey) Orr-
MUST
HAVE THE FOLLOWING I{019 7 7 —31 s
A. Consent for Sheriff to inspect bank account containing Bingo profits.
B. Statement of ownership/lease of premises.
C. Copies of exempt status from Internal Revenue and Franchise Tax Board
or tax identification number.
D. Floor plan of room where gaming will take place showing the exit(s)
E. Will food or drinks be served?Y )� N
II{�ff yes, describe the type, how it will be served, and where it will be prepared
1'GV'cha ec�, T y CCC+rA Sum) f Y I e w ESL(`� rJP yr� (�r+-I S):] Si..lc�1 e4.S
eA �i��c U. n� 9'j e � . , p °c k1� P. Cr&ee�, �v+cQ
voppred IV) C"O pefliv,10
cv/r�46 ;
Signature of person responsible for Bingo game
FEE: $50.00 -General License annual. Over 10 games.
5.00-General License each game. Under 10 games.
THIS PERMIT IS NONTRANSFERABLE EITHER AS TO THE LICENSE OR LOCATION
FOR OFFICIAL USE ONLY
Sheriff recommendation YES ✓' NO
Fire District YES NO
Health Officer YES �" NO
Chief Building Inspector YES—V�NO
Director of Planning YES V'NO
Time of public hearing dbf�
Business License No.
Cupertino Senior Center Coordinating Council
2011-2012 Officers and Addresses:
Ron Moore(President)
19967 Pear Tree Court
Cupertino, CA 95014
I
Billie Atwood (Vice President)
1024 Corvette Dr.
San Jose, CA 95129
Alice Endter(Recording Secretary)
999 Pendleton Ave.
Sunnyvale, CA 94087
Jill Rozmiarek (Corresponding Secretary/Treasurer)
4571 Madoc Way
San Jose, CA 95130
Amanda Cuva(Bingo Committee Chairperson)
18890 Tuggle Ave.
Cupertino, CA 95014
I
I
I
i
APPLICATION FOR BINGO PERMIT
i
The Santa Clara County Sheriff's Department may inspect the Bingo Records of the
Cupertino Senior Center.
The premises used for the Cupertino Senior Center Bingo are owned by the City of
Cupertino.
i
Amanda Cuva
Bingo Committee
Tax Exempt Status:
i
The City of Cupertino's Tax Exempt I.D. #is 94-6027368.
The Domestic Nonprofit Corporation is the Cupertino Senior Coordinating Council.
Corporation No. 0899275-CS3CC.
i
lelavich
epostcard@urban.org
Friday, October 29, 2010 3:26 PM
Senior Center
,ubject: Form 990-N E-filing Receipt- IRS Status:Accepted
Organization: CUPERTINO SENIOR COORDINATING
EIN: 94-2853675
Submission Type: Form 990-N
Year: 2009
Submission ID: 7800582010302dz93740
e-File Postmark: 10/29/2010 6:20:30 PM
Accepted Date: 10/29/2010
The IRS has accepted the e-Postcard described above. Please save this receipt for your
records.
Thank you for filing.
------------------------------------------------------------------------
e-Postcard technical support
Phone: 866-255-0654 (toll free)
email:ePostcard@urban.org
-------------------------------------------------------------------------
CUPERTINO SENIOR COORDINATING
21251 Stevens Creek Blvd
Cupertino, CA 95014
I
1
Cupertino Senior Center
21251 Stevens Creek Boulevard
Cupertino,CA 95014-3255
CI[TY OFg p� (� (408)777-3150
U P E"If I\ 11�V B (408)779-3156
PARKS AND RECREATTON DEPARTMENT
� x,fS i'A ca r-ke cl in re d te}A
Storage. a
17 ,
Kkohen
,0 -
T Dance Floor
Restmom,Women -
'r CorfferenGo Room
�YllGI�� r n i.
I
Restroom, Men -
Reception Hall
DECK I
Qj
Lounge Main Entra u
1 _ .
OFFICE OF THE CITY CLERK
I
CITY HALL
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
C U P E RT I N O TELEPHONE: (408) 777-3223 • FAX: (408)777-3366
I
November 1, 2011
Linda Yelavich
Cupertino Senior Center Coordinating Council
21251 Stevens Creek Blvd.
Cupertino, CA 95014
i
Re: Renewal of Bingo Permit
i
Pursuant to Section 5.32.290 of the Cupertino Municipal Code, the Cupertino City Council
conducts a public hearing each January regarding renewal of bingo permits. The hearing is
scheduled for Tuesday, January 17, 2012, Council Chamber, Community Hall, 10350 Torre
Avenue, Cupertino, California.
To allow enough time for the required verifications by the Santa Clara County Fire Department and
the Sheriff's Department, the application should be completed and returned to this office by Friday,
December 2.
j
Sincerely,
Grace Schmidt
Deputy City Clerk
cc: Code Enforcement
i
i
i
i
i
I