09. ABC Whole Foods
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax: (408) 777-3366
CITY OF
CUPEI\TINO
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER 1
AGENDA DATE NO"Y~f 5'; :2b7J7
SUBJECT AND ISSUE
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Whole Foods Market
20955 Stevens Creek Blvd.
Market
Off Sale Beer & Wine (20)
On Sale Beer & Wine-Eating Place (41)
On Sale Beer & Wine-Public Premises (42)
Original Fees and Annual Fee
Reason for Application:
RECOMMENDATION
There are no use permit restrictions or zoning restrictions which would prohibit this use and staff
has no objection to the issuance ofthe license.
Prepared by:
Submitted by:
~-l
~L~ UlifLdlLli
Ciddy Wordell, City Planner
IV~
David W. Knapp, City Manager
9 - 1
Printed on Recycled Paper
.. ."" .
Department of Aic~holic Beverage Control
APPLICA TIONFOR ALCOHOLIC BEVERAGE LlCENSE(S)
ABC 211 (6199)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Rm. 119
San Jose, CA 95113
(408)277-1200
DISTRICf SERVING LOCATION:
Control
File Number: 453866
Receipt Number: 1637661
Geographical Code: 4303
Copies Mailed Date: October
Issued Date:
17, 2007
First Owner:
Name of Business:
SAN .JOSE
WHOLE FOODS MARKET CALIFORNIA INC
WHOLE FOODS MARKET
Location of Business:
20955 STEVENS CREEK BLVD
CUPERTINO, CA 95014-2107
SANTA CLARA
Yes
Census Tract 5078.06
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
5980 HORTON ST
STE 200
EMERYVILLE, CA 94608-2057
Type of license(s): 20, 42, 41
Transferor's license/name:
Dropping Partner:
Yes_ No
License Type Transaction Type Fee Type Mas~er I2Y.n :r2m &
41 ON-SALE BEER AND ORIGINAL FEES NA y 0 10/17/07 $30Q.00
41 ON-SALE BEER AND ANNUALFBE NA y 0 10/17/07 $304.00
Total $604.00
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 .Ycs. answer to tbe 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: October 17, 2007
Under penalty of perjury, each person whose signature appears beiow. certifies and says: (1) He is an applicant, or one of the applicants. or an
executive officer of the applicant corpomtion. 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 thaI each of the above statements therein made are true; (3) thaI no person other
Ihanthe applicanl or applicants has any direct or indirect interesl in the applicant or applicant's business to be conducled under the Iicense(s) for
which Ibis application is made; (4) that the tmnsfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
agreement entered inlo more thau ninety (90) days preceding the day on which the transfer application is rued with the Department or to gain or
establish a prefetence to or for any creditor or transferor or to defmud or injure. any creditor of transferor; (5) that the transfer applicalion may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s)
WHOLE FOODS MARKET CALIFORNIA INC
Applicant Signature(s)
See 211 Signature Page
9-2
State of California
APPLICATION SIGNATURE SHEET ("SIGN ON")
Department of Alcoholic Beverage Control
. This form is to be used as the signature pag~ 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.
2. FIlE NUMBER (If Rny) 3. LICENSE TYPE
1. OWNERSHIP TYPE (Chec:k one)
B Sole Owner
Partnership
o Husband & Wife
o Partnership-Ltd
4. mANSACTIDN TYPE
I8l Corporation
.0 Limited Liability Company
o Other
453866
41
~ Original
o Exchange
o Person to Person Transfer
o Premise to Premise Transfer
o Other
6.. APPUCANT(S) NME (lBo~ "'1, middle)
Whole Foods Market California, Inc.
6. APPUCANrS MAILING ADDRESS (51(881 addressIP.O. box, clIy, BiBle. zip code)
5980 Horton St. Ste 200, Emeryville, CA 9460B
7. PREMISES ADORJ:SS (St1IIeI addf_, oily, zip code)
20955 Stevens Creek Blvd., Cupertino, CA 95014
APPLICANT'S CERTIFICA TlON
Under penalty of perjury each person whose signature appears payment of a loan or to fulfill an agreement entered into more than
below, ccrtifies and says:' (I) He/She is an applicant. or one of ninety (90) da)'s preceding the day on which the transfer
the applicants, or an executive officer of the applicant application is filed with the Department '(b) to gain or establish a
corporation., named in the foregoing !IP~licatjon, duly authorized preference to or for any creditor or transreror, or (c) to defraud or
to make this application on its behalf; (2) that he/she has read miure any creditor or transferor; (5) that the transfer application
the foregoing and knows the contents thereof and that each of the may be withdrawn by either the applicant or the licensee with no
above statements thtll'ein made are true; (3) that nO person other resulting liability to the Department.
th.an the appJicllDt or applicants has any dIrect or indirect interest I understand that if I fail to qualify for the license or withdraw this
in the applicant or applicant's business to be conducted under the application there will be a servIce cnarge of one-fourth of the
license(s) for which this application is made; (4) that the transfer hcense fee paid, up to $100.
application or proposed transfcr is not made to (a) satisfy the
SOLE OWNER
PRINTED NAME (lall, Iflll~ mldde) I ~GNATURE I DATE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
9. PARTNER'S PRINTED NAME (laII. ftrsI. middle) SIGNATURE DATE SIGNED
X
PARTNER'S PRINTED NAME 1l.B&l, IlrII, m1ddla) SIGNATURE DATE SIGNED
X
PARTNER'8 PRINTED NAME (LB8I, llrcI. rnIdde) SIGNATURE DATE SIGNED
X
CORPORATION
10. PRINTED NAME (1.811, IlrII, 1I1klch)
SIGNATURE
X Signed in counterpart
DATE SIGNED
TITLE
/ I8l Presiden~ 0 Vice _Presi~~!1t
V:' PRINTED NAME (L1IllI~ firol, mIddla)
Percival, Albert E.
TITLE
t8l Secretary 0 Asst. Secretary
LIMITED LIABILITY COMPANY
11. The Umited liability company Is member-run 0 Yes 0 No (If no. camp
12. NAME Of DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (las~ n,ot, middle)
13. t.EM8ER'S PRINTED NAME fLail. !irIl, middle)
SIGNATURE
x
MEMBER'S PRINTED NAME (\.MI, fiIIII. middle)
SIGNATURE
DATE SIGNED
ABC-211-SIG (2/03)
X
o-i'GN p:WflM )
9-3
State of Call fomi a
APPLICATION SIGNATURE SHEET ('"SIGN ON")
Department of Alcoholic Beverage Control
. This form is to be used as the signature page for
applications not signed in the Disllict Office.
. Read instructions on reverse before completing.
. All signatures must be notarized In accordance with
laws of the State where signed.
2. FILE NUMBER (U any) 3. LICENSE TYPE
453866
41
6. APPLlCANT(S) NAME (last, ,..t, middle)
Whole Foods Market California, Inc.
6. APPLlCANT'S MAILING ADDRESS (51'ee1 addreBBIP.O. bllJ(, Illy, slate, zlp code)
5980 Horton st. Ste 200, Emeryville, CA 94608
7. PREMISES ADDRESS (Slreet address, cily, zip code)
1. OWNERSHIP TYPE (CII.ck one)
o Sole Owner .
o Partnership
o Husband & Wife
o Partnership-Ltd
4. TRANSACTION TYPE
181 Corporation
o Limited Liability Company
o Other
~ Original
o Exchange
o Person to Person Transfer
o Premise to Premise Transfer
o Other
20955 Stevens Creek Blvd., Cupertino, CA 95014
APPLICANT'S CERTlFICA TlON
payment of a loan or to fulfill an agreemenfentered 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
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 ifl fail to qualify for the licem.e or withdraw this
application there will be a servIce charge of one-fourth of the
hcense fee paid, up to $100. .
. Under penalty of perjury each person whose siguature appears
below, certifies and says: (I) He/She is an applicant, or one of
the applicants, or an execlltive officer of the applicant
corporation, named in the foregoing apQlication, duly authorized
to make this application on its behalf; (2) that he/she bas read
the foregoing and knows the .contents thereof and tbat each of the
above statements tberein made are true; (3) that no person otber
tbon 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 (a) satisfy tbe
._.S-OLE OWNER
8. PRINTED NAME (Le8l.1lr&I. middle) I ~IGNATllRE I DATE SIGNED
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
II. .PARTNER'S PRINTED NAME (Last, Iirat. middle) SIGNATURE DATE SIGNED
x
PARlNER'S PRINTED NAME (LB&~ IIrsl, m1dcle)
SIGNATURE
x
PARTNER'S PRINTED NAME (LBSI. fnl, middle)
SIGNATURE
DATE SIGNED
DATE SlGNEP
C.ORPORATION
/'0. PRINTED NAME (Last. firs!, middle)
n. _ Anthony Gilmore
, L TinE
181 President 0 Vice President
.... PRINTED NAME (l.RBI. fi,"" middle)
Percival, Albert E.
TITLE
I DATE SIGNED .
19-~S-O(
I DATE SIGNED
~ Secretary DAsst. Secretary o Chief FinanciaJ Officer DAsst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is membeHun DYes 0 No
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, fi.... middle)
13. MEMBER'S PRINTED NAME (La", 1nI. middle)
SIGNATURE
x
MEMBER'S PRINTED NAME (I,.BSt, fira~ middle)
/
/
ABC-211-SIG (2ft)
SIGNATURE
(If no, complete Item #12 below)
ABC INITIALSlDATE (ABC use Dfiy)
DATE SIGNED
DATE SIGNED
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of
C~l~foY'rli~
Al~t'1ea~
/;/1.5""/"7
0"",;.> E. I L lve#'"O "'I ,N\)~ tpolbl i e-
before me, fT""
~~~ C,'Jr-11""1l.
Name and TIlle 01 OllJeer (e.g., "Jane Doe, Nolaty PubHc')
County of
On
Dale
personally appeared
Name(s) 01 SlgneI(s)
o personally known to me - OR - ~ved 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 hislherltheir authorized capacity(les), 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.
Sigll8lure 01 NolaJy Pubic
OPTIONAL
Though the information below Is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document
Description of Attached Document
IINJ"I ,- L' J,'..... ",1. - ..L_e;t-
TItle or Type of Document: -- r" ;~.~ :l.",...'J"V""o"'"I'"
Document Date: 6!z. f J..'f Number of Pages:
Slgner(s) Other Than Named Above:
Capaclty(les) Claimed by Signer(s)
Signer's Name:
Signer's Name:
o Individual
o Corporate Officer
T1tle(s):
o Partner - 0 Umlted 0 General
o Attorney-in-Fact
o Trustee
o Guardian or Conservator
o other:
.
Top of thumb here
o Individual
o Corporate Officer
TItle( s): .
o Partner - 0 Umlted 0 General
o Attorney-In-Fact
o Trustee
o Guardian or Conservator
o Other:
RIGHT THUfllBPRINT
OF SIGNER
Top of thumb here
Signer Is' Representing:
Signer Is Representing:
01995 National NoIaty A&lIoclaIion . 8236 Remmel I<ve., P.O. Box 7184' Canoga Park, CA 111309.7184
Prod. No. 5907
RIlOl'd8r. CeU Toll-Free 1-800-876-6827