09. ABC licenses
ITY F
CUPEIQ"INO
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER q A
AGENDA DATE April 3, 2007
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
Hilton Garden Inn Cupertino
10741 N. Wolfe Road
HotellRestaurant
On-Sale General for Bona Fide Public Eating Place (47)
Person-to-Person Transfer and Annual Fee
RECOMMENDATION
There are no use permit restrictions or zoning restrictions which would prohibit this use and staff
has no objection to the issuance of the license.
Prepared by:
Submitted by:
~h~
CIddy Word 1, CIty Planner
~
David W. Knapp, City Manager
q fI-(
Printed on Recycled Paper
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Rm. 119
San Jose, CA 95113
(408)277-1200
DISTRICT SERVING LOCATION:
Control
File Number: 451338
Receipt Number: 1604623
Geographical Code: 4303
Copies Mailed Date: March 8, 2007
Issued Date:
First Owner:
Name of Business:
SAN JOSE
SAND HILL HOTEL MANAGEMENT LLC
HILTON GARDEN INN CUPERTINO
Location of Business:
10741 N WOLFE RD
CUPERTINO, CA 95014-0613
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Yes
Census Tract 5081.01
489 S EL CAMINO REAL
SAN MATEO, CA 94402
Type of license(s): 47
Tran sferor' s license/name:
363925 / SAND HILL MANl Dropping Partner:
Yes_
NoL
License Type Transaction Type Fee Type Master Dup Date
47 ON-SALE GENERAL] PERSON TO PERSON TRANSF P40 Y 0 03/08/07
47 ON-SALE GENERAL] ANNUAL FEE P40 Y 0 03/08/07
30 TEMPORARY PERM! DUPLICATE NA Y 1 03/08/07
Total
Fee
$1,250.00
$758.00
$100.00
$2,108.00
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 premise 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: March 8,2007
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 licensees) for
which this application is made; (4) that the transfer application or proposed transfer is not made to satisfy the 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 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)
Applicant Signature(s)
SAND HILL HOTEL MANAGEMENT LLC
See 211 Signature Page
QA'-z..
Department of Alcoholic Beverage Control
State of California
APPLICATION SIGNATURE SHEET (USIGN ON")
. This form is to be used as the signature page for
applications not signed in the District Office.
. Read instructions on reverse before completing.
All signatures must be notarized in accordance with
laws of the State where signed,
1 OWNERSHIP TYPE (Check one)
B Sole Owner
Partnership
o Husband & Wife
o Partnership-Ltd
o Corporation
[2] Limited Liability Company
o Other
2 FILE NUMBER (it any)
3. LICENSE TYPE
4. TRANSACTION TYPE
363925
47
5. APPLlCANT(S) NAME
SAND HILL HOTEL MANAGEMENT, LLC
o Original
o Exchange
o Person to Person Transfer
D Premise to Premise Transfer
D Other
6. APPLICANT'S MAILING ADDRESS (Streel address/P.O. box, cily, stale, Zip code)
489 South El Camino Real, San Mateo, CA 94402
7. PREMISES ADDRESS (Slreet address, cily, zip code)
10741 N, Wolfe Road, Cupertino, CA 95014
APPLICANT'S CERTlFICA TlON
Under penalty of perjury, each person whose signature appears
below, certifies and says: (I) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing aPElication, 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
application or proposed transfer is not made to (a) satisfy the
SOLE OWNER
B. PRINTED NAME (Lasl, first, middle) I ~GNATURE
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures
9. PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
x
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
x
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
x
CORPORATION
payment of a loan or to fulfill an agreement entered into more than
ninety (90) da)'s 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
1l1jure 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.
of general partners
I DATE SIGNED
I
only)
I DATE SIGNED
I
10. PRINTED NAME (Last, first, middle)
I SIGNATURE
IX
\ DATE SIGNED
TITLE
D President D Vice President
PRINTED NAME (Last, first, middle)
D Chairman of the Board
I ~GNATURE
I DATE SIGNED
TITLE
o Secretary 0 Asst. Secretary 0 Chief Financial Officer D Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run 0 Yes [2] No
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middlell
Peter Suen Yiu Pau, Managing Member .'
13. MEMBER'S PRINTED NAME (Last, first, middle)
t/
(If no, complete Item #12 below)
ABC INITIALSIDATE (ABC use only)
X
MEMBER'S PRINTED NAME (Last, first, middle)
SIGNATURE
X
ABC-211-SIG (9/01)
"SIGN ON"
Y1c
~h
(] /f:
l:/-~ J Yn
'1A-3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
STATE OF CALIFORNIA
,/ /1__ /
COUNTY OF :2 t1.LJL
On /)-/ (s~ 1
DATE
lill} Tc-v
before me,
1<i7/r;- y/1{', A~l/1t'Y' PI{6LtG
N~E:TITLE bF OFF{CER - E.G.., "JANE'DOE, NOTARY PUBLIC
i/. fJkU
personally appeared,
PtT&-1?-
I
personally known to me (or proved to me on the basis of satisfactory evidence) to be the
person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me
that he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which
the person( s) acted, executed the instrument.
WITNESS my hand and official seal.
, 7
~~
(SEAL)
r - - -.. - - - - - - - - - I
~" KATIEYAO
r" """. , COMM. # 1708692 -1
o ~.. ' NOTARY PUBLlC'CALlFORNlAO
~- . SAN MATEO COUN1'f 0
1 . . My Commisaion Expires T
',-,.~' December 5. 2010
- - ~ ~ ~ ~ - ~ ~ ~ ~ ~
OPTIONAL INFORMATION
TIllS OPTIONAL INFORMATION SECTION IS NOT REQUIRED BY LAW BUT MAYBE BENEFICIAL TO PERSONS REL YlNG ON lIDS NOT ARlZED DOCUMENT.
TITLE OR TYPE OF DOCUMENT
DATE OF DOCUMENT
NUMBER OF PAGES
SIGNERS(S) OTHER THAN NAMED ABOVE
SIGNER'S NAME
SIGNER'S NAME
RIGHT THUMBPRINT
RIGHT THUMBPRINT
qfl-tf
CITY OF
CUPEIUINO
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER ~ 13
AGENDA DATE April 3, 2007
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
Lucky Stores Inc.
10425 S. De Anza Blvd.
Supermarket
Off-Sale General (21)
Stock Transfer Multiple
RECOMMENDATION
There are no use permit restrictions or zoning restrictions which would prohibit this use and staff
has no objection to the issuance of the license.
Prepared by:
Submitted by:
e~ .??/o$<0?~
Ciddy Wordell, City Planner
~
David W. Knapp, City Manager
q (3-1
Printed on Recycled Paper
RECEIVED ~~f1R 1 6
- hUi 2007
Departll1t,nt of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Pas eo de San Antonio
Rm. 119
San Jose, CA 95113
(408)277-1200
DISTRICT SERVING LOCATION:
Control
File Number: 449799
Receipt Number: 1604992
Geographical Code: 4303
Copies Mailed Date: March 1~, 2007
Issued Date:
First Owner:
Name of Business:
SAN JOSE
LUCKY STORES INC
Location of Business:
10425 S DE ANZA BLVD
CUPERTINO, CA 95014-3081
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Census Tract 5077.01
PO Box 4278
Modesto, CA 95352-4278
Type of licensees): 21
Transferor's license/name:
449799 / LUCKY STORES Il Dropping Partner:
Yes
No
y
Dup
o
Date
Fee
License Type
Transaction Type
Fee Type
Master
21 OFF-SALE GENERAL STOCK TRANSFER MULTIPLE N A
0311 0/07
Total
$124.00
$124.00
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 premise 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: March 10, 2007
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 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 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)
Applicant Signature(s)
LUCKY STORES INC
c,,3 - 2
Department of Alcoholic Beverage Control
State of California
A PPLlCA TION SIGNA TU RE SHEET ("SIGN ON")
. This form is to be used as the signature page for
applications not signed in the District Office.
. Read instructions on reverse before completing.
. All signatures must be notarized in accordance with
laws of the State where signed.
1 OWNERSHIP TYPE (Check one)
D Sole Owner
o Partnership
D Husband & Wife
D Partnership-Ltd
[2] Corporation
D Limited Liability Company
D Other
2 FILE NUMBER (il any)
3. LICENSE TYPE
4. TRANSACTION TYPE
21
D Original
D Exchange
D Person to Person Transfer
D Premise to Premise Transfer
[2] Other STOCK TRANSFER
5. APPLlCANT(S) NAME (Last, firs I. middle)
LUCKY STORES, INC.
6. APPLICANT'S MAILING ADDRESS (Slreet addresslP 0 box. city. slale. Zip code)
I 800 STANDIFORD A VENUE, MODESTO, CALIFORNIA 95350
7. PREMISES ADDRESS (Slreet address. city, zip code)
v VARIOUS LOCATIONS
APPLICANT'S CERTlFICA TION
payment of a loan or (0 fulfill an agreement entered into more than
ninety (90) days preceding the day on which the transfer
application is filed with the Departmen~ (b) to gain or establish a
preference to or for any creditor or transleror, or (cl (0 defraud or
mjure 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! fail to qualify for the license or withdraw this
application there will be a service cfiarge of one-fourth of the
license fee paid, up to $] 00.
Under penalty of perjury, each person whose signature appears
below, certifies and says: (I) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing ap,Qlication, 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
application or proposed transfer is not made to (a) satisfy the
SOLE OWNER
8. PRINTED NAME (Last, first, middle) I ~GNA TURE IDA TE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNER'S PRINTED NAME (Lasl, firsl, middle) SIGNATURE DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle) SIGNATURE DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle) SIGNATURE DA TE SIGNED
X
CORPORA TION
IDA TE SIGNED
r::::)~ -
-- ~'. ......--..
-' -
10. PRINTED NAME (Last, first, middle)
V"'''ll C i'l q e-i '), Sf' \ lJ e I ~ ~
TITLE
D President
TITLE
D Secretary D Asst. Secretary QI Chief Financial Officer 0 Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The lim ited liability company is member-run
ABC INITIALS/DA TE (ABC use only)
D Yes DNa
(If no, complete Item #12 below)
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Lasl. fIrsl, middle)
X
DATE SIGNED
13 MEMBER'S PRINTED NAME (Lasl, [list, middle)
SIGNATURE
MEMBER'S PRINTED NAME (Last, IIISt, middle)
SIGNA TURE
X
DA TE SIGI~ED
ABC-211-SIG (2/03)
"SIGN ON"
98-3
CALIFORNIA ALL~PURPOSE ACKNOWLEDGMENT
No. 5907
_,~e~~~~"2288~&@
State of Ca] ifornia
County of stanislaus
On '1-<.J~/(,~<_"~,_ /7 ). 0(.7
DATE
before me,
l!Phra K. Keeler
NAME. TITLE OF OFFICER. E.G.. "JANE DOE, NOTARY PUBLIC"
personally appeared
Ron Riesenbeck
NAME(S) OF SIGNER(S)
lXJ personally known to me M OR - 0 proved to me on the basis of satisfactory evidence
to be th e pe rson (~) whose n am e(9,1 i s/ar:e
subscribed to the within instrument and ac-
knowledged to me that he/~heiibay executed
the same in hislh.e:r.~r authorized
capacitYUe~, and that by his/h:er/A~1r
signature(-=SJ on the instrument the person(~),
or the entity upon behalf of which the
person(s1 acted, executed the instrument.
t DEBRA K. KEE LER
a. ....... ' . Commission /I 1705206
_ . . Notary Public. California
~ ~-".. Stanislaus County I
l' Myecmn. ExpI/elI[)eC 10, 2010
- - - . - ~ - - . - - . - y - - - - .
. WITNESS my hand and official seal.
~-,J-<--/L '--t(~-<-
SIGNATURE OF NOTARY
OPTIONAL
--
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this foriJl.
CAPACITY CLAIMED BY SIGNER
D INDIVIDUAL
IB CORPORATE OFFICER
V.p, C,c.l).
TITLE(S)
DESCRIPTION OF ATTACHED DOCUMENT
U-1j2-f) , .)~ . ~.U.~~)-
r I TITLE OR TVPE OF DOCUMENT
D PARTNER(S)
o LIMITED
D GENERAL
I
o ATIORNEY-IN-FACT
o TRUSTEE(S)
o GUARDIAN/CONSERV A TOR
o OTHER:
NUMBER OF PAGES
2. / / CI /0 7
I
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR EN.TITY(IES) S"
~") 0 -(7 Uv1(J. v'l . L{ (ieX (/VI.C<..k e~b
/
SIGNER(S) OTHER THAN NAMED ABOVE
qB-'f
@1993 NATIONAL NOTARY ASSOCIATION' 8236 Remme! Ave., P.O. Box 7184' Canoga Park, CA 91309-7184
CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT
No 5907
- \ I
(' ';fJ, '.
State of c.;;o.~cJC/~J~Lc-\.
)\ (!~ ,(I
County of. . A--LZj:.~,-,u~.~!~
On 1~_J.,. Jb ,lcJcl7
/
before me,
(~ . .
J .€- L .r ~ I (. I(.c. c (cv'
NAME, TITLE OF Of-flCER. E.G.. ',JAI~I, DOE. NOTAFIY PUBLIC"
S't' \ U e: I v: .:"~
NAME(S) OF SIGNER(S)
DATE
personally appeared
I ( rr
\tv 'l I C /\(.::/ r.:::. ( -.\
If personally known to me - OR - 0 proved to me on the basis of satisfactory evidence
to be the person(.s.) whose name(~) is/ar;e
subscribed to the within instrument and ac-
knowledged to me that he/sBettlwy executed
the same in his/bB:r--/:!:l:teir authorized
capacity(te's), and that by his/h~ir
signature(~) on the instrument the person(sj,
or the entity upon behalf of which the
person(~) acted, executed the instrument.
l DEBRA K KEELER f
. '......' Commission # 1705206
;;~_. Notary Public - California ~
~ '. Stanislaus County j
t y'~ y' y _~~,~~l~,:O~O ~
WITNESS my hand and official seal.
o (\ -.
f -~~~.~ I L 't ( ~k,,--
SIGNATURE OF NOTARY
OPTIONAL
..L ....
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form,
CAPACITY CLAIMED BY SIGNER
o INDIVIDUAL
IE CORPORATE OFFICER
U ' P, /~ fA. V."C( VI, (2 e s,c:;,-, VCr:; '>
TITLE(S)
DESCRIPTION OF ATTACHED DOCUMENT
/... )\ -: \ /I . 'I
LXfl-D' . /.L-L'l/1.~X-~ ../~-><:.=--t
r TITLE OR TYPE OF DOCUMENT
o PARTNER(S)
o LIMITED
o GENERAL
(
NUMBER OF PAGES
o ATIORNEY-IN-FACT
o TRUSTEE(S)
o GUARDIAN/CONSERVATOR
o OTHER:
':t I f 9' 107
. I '
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAlvlE OF PERSON{S) OR ENTITY(IES)
Sq [/ e. U\. \0. .. + S 1-( p. y' VV\,:7v' /L~J'7
I
SIGNER(S) OTHER THAN NAIv1ED ABOVE
98-5
<91993 NATIONAL NOTARY ASSOCIATION' 8236 Remmel Ave.. PO. Box 7184' Canoga Park, CA 91309-7184