TY CUPEQ NO F City Ha 10300 Torre Avenue Cupertino CA 95014 408 777 3212 Fax 408 777 3366 OFFCE OF THE CTY MANAGER SUMMARY AGENDA TEM NUMBER qa AGENDA DATE Apri 3 2007 SUBJECT AND SSUE Appication for Acohoic Beverage License BACKGROUND 1 Name ofbusiness Location Type ofbusiness Type oflicense Reason for Appication Hiton Garden nn Cupertino 10741 N Wofe Road HoteRestaurant On Sae Genera for Bona Fide Pubic Eating Pace 47 Person to Person Transfer and Annua Fee RECOMMENDATON There are no use permit restrictions or zoning restrictions which woud prohibit this use and staff has no objection to the issuance ofthe icense Prepared by Submitted by h Cddy Word 1 Cty Panner David W Knapp City Manager q f Printedon Recyced Paper
Department of Acohoic Beverage Contro APPLCATON FOR ALCOHOLC BEVERAGE LCENSE S State of Caifornia ABC 211 6 99 TO Department of Acohoic Beverage 100 Paseo de San Antonio Rm 119 San Jose CA 95113 408 277 1200 Contro Fie Number 451338 Receipt Number 1604623 Geographica Code 4303 Copies Maied Date March 8 2007 ssued Date DSTRCT SERVNG LOCATON First Owner Name of Business Location of Business County s premise inside city imits Maiing Address f different from premises address SAN JOSE SAND HLL HOTEL MANAGEMENT LLC HLTON GARDEN NN CUPERTNO 10741 N WOLFE RD CUPERTNO CA 95014 0613 SANTA CLARA Yes Census Tract 5081 01 489 S EL CAMNO REAL SAN MATEO CA 94402 Type of icense s 47 Tran sferor s icense name 363925 SAND HLL MAN Dropping Partner Yes NoL License Type Transaction Type Fee Type Master Dup Date Fee 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 DUPLCATE NA Y 1 03 08 07 Tota 1 250 00 758 00 100 00 2 108 00 Have you ever been convicted of a feony No Have you ever vioated any provisions of the Acohoic Beverage Contro Act or reguations Department pertaining to the Act No Expain any Yes answer to the above questions on an attachment which sha be deemed part of this appication of the Appicant agrees a that any manager empoyed in an on sae icensed premise wi have a the quaifications of a icensee and b that he wi not vioate or cause or to permit be vioated any of the provisions of the Acohoic Beverage Contro Act STATE OF CALFORNA County of SANTA CLARA Date March 8 2007 Under penaty of perjury each person whose signature appears beow certifies and says 1 He is an appicant or one of the appicants or an executive officer of the appicant corporation named in the foregoing appication duy authorized to make this appication on its behaf 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 appicant or appicants has any direct or indirect interest in the appicant or appicant s business to be conducted under the icensees for which this appication is made 4 that the transfer appication or proposed transfer is not made to satisfy the payment of a oan or to fufi an agreement entered into more than ninety 90 days preceding the day on which the transfer appication is fied with the Department or to gain or estabish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor 5 that the transfer appication may be withdrawn by either the appicant or the icensee with no resuting iabiity to the Department Appicant Name s s Appicant Signature SAND HLL HOTEL MANAGEMENT LLC See 211 Signature Page QA z
State of Caifornia APPLCATON SGNATURE SHEET USGN ON Department of Acohoic Beverage Contro This form is to be used as the signature page for appications not signed in the District Office Read instructions on reverse before competing A signatures must be notarized in accordance with aws of the State where signed 2 FLE NUMBER it any 363925 47 5 APPLCANT S NAME SAND HLL HOTEL MANAGEMENT LLC 1 OWNERSHP B TYPE Check one Soe Owner Partnership o Husband o Partnership Ltd 3 LCENSE TYPE 4 TRANSACTON TYPE o Origina o Exchange Wife o Corporation 2 Limited Liabiity Company o Other o Person to Person Transfer D Premise to Premise Transfer D Other 6 APPLCANTS MALNGADDRESS Stree address P O box ciy stae Zip code 489 South E Camino Rea San Mateo CA 94402 7 PREMSES ADDRESS Sreet address ciy zip code 10741 N Wofe Road Cupertino CA 95014 Under penaty of perjury each person whose signature appears beow certifies and says He She is an appicant or one of the appicants or an executive officer of the appicant corporation named in the foregoing apeication duy authorized to make this appication on its behaf 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 appicant or appicants has any direct or indirect interest in the appicant or appicant s business to be conducted under the icense s for which this appication is made 4 that the transfer appication or proposed transfer is not made to a satisfy the SOLE OWNER B PRNTED NAME Las first midde PARTNERSHP LMTED PARTNERSHP APPLCANT S CERTFCA TON GNATURE Signatures 9 PARTNER SPRNTED NAME Last first midde SGNATURE x payment of a oan orto fufi an agreement entered into more than ninety 90 da s preceding the day on which the transfer appication is fied with the Department b to gain or estabish a preference to or for any creditor or transferor or c to defraud or 11jure any creditor or transferor 5 that the transfer appication may be withdrawn by either the appicant or the icensee with no resuting iabiity to the Department understand that if fai to quaify for the icense orwithdraw this appication there wi be a servce charge of one fourth of the cense fee paid up to 100 of genera partners ony DATE SGNED DATE SGNED PARTNER S PRNTED NAME Last first midde SGNATURE x DATE SGNED PARTNER SPRNTED NAME Last first midde SGNATURE DATE SGNED x CORPORATON 10 PRNTED NAME Last first midde TTLE D President D Vice President PRNTED NAME Last first midde TTLE SGNATURE D Chairman ofthe Board GNATURE o Secretary 0 Asst Secretary 0 ChiefFinancia Officer DAsst Treasurer LMTED LABLTY COMPANY DATE SGNED DATE SGNED 11 The imited iabiity company is member run 0 Yes 2 No f no compete tem 12 beow 12 NAME OF DESGNATED MANAGER MANAGNG MEMBER OR DESGNATED OFFCER Last first midde ABC NTALSDATE ABC useony t Peter Suen Yiu Pau Managing Member 13 MEMBER S PRNTED NAME Last first midde MEMBERS PRNTED NAME Last first midde SGNATURE ABC 211 SG 9 01 SGN ON Y1c h f JYn 1A 3
CALFORNA ALL PURPOSE ACKNOWLEDGEMENT STATE OF CALFORNA COUNTY OF 1 2 t1 LJL i Tc v On s 1 DATE personay appeared before me PtT 1 1i7r y1 A1tY P 6LtG N E TTLEbF OFF CER E G JANE DOE NOTARY PUBLC i fjku personay 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 acknowedged 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 behaf of which the person s acted executed the instrument to me WTNESS my hand and officia sea 7 SEAL r KATEYAO r COMM 1708692 1 o NOTARY PUBLC CALFORNAO SAN MATEO COUN1 f 0 My Commisaion Expires December 5 2010 1 T OPTONAL NFORMATON TS OPTONAL NFORMATON SECTON S NOT REQURED BY LAW BUT MAYBE BENEFCAL TO PERSONS RELYNG ON DS NOT ARZED DOCUMENT TTLE OR TYPE OF DOCUMENT DATE OF DOCUMENT NUMBER OF PAGES SGNERS S OTHER THAN NAMED ABOVE SGNER S NAME SGNER S NAME RGHT THUMBPRNT RGHT THUMBPRNT qf tf
CTY OF CUPEUNO City Ha 10300 Torre Avenue Cupertino CA 95014 408 777 3212 Fax 408 777 3366 OFFCE OF THE CTYMANAGER SUMMARY AGENDA TEM NUMBER 13 AGENDA DATE Apri 3 2007 SUBJECT AND SSUE Appication for Acohoic Beverage License BACKGROUND 1 Name ofbusiness Location Type ofbusiness Type oflicense Reason for Appication Lucky Stores nc 10425 S De Anza Bvd Supermarket Off Sae Genera 21 Stock Transfer Mutipe RECOMMENDATON There are no use permit restrictions or zoning restrictions which woud prohibit this use and staff has no objection to the issuance ofthe icense Prepared by Submitted by e o 0 Ciddy Worde City Panner David W Knapp City Manager q 3 1 Printed on Recyced Paper
RECEVED hui f1r 1 6 2007 Depart1t nt of Acohoic Beverage Contro APPLCATON FOR ALCOHOLC BEVERAGE LCENSE S ABC 211 6 99 State of Caifornia TO Department of Acohoic Beverage 100 Pas eo de San Antonio Rm 119 San Jose CA 95113 408 277 1200 Contro Fie Number 449799 Receipt Number 1604992 Geographica Code 4303 Copies Maied Date March 1 2007 ssued Date DSTRCT SERVNG LOCATON First Owner SAN JOSE LUCKY STORES NC Name of Business Location of Business County 10425 S DE ANZA BLVD CUPERTNO CA 95014 3081 SANTA CLARA s premise inside city imits Census Tract 5077 01 Maiing Address f different from premises address PO Box 4278 Modesto CA 95352 4278 Type of icensees 21 Transferor s icense name 449799 LUCKY STORES Dropping Partner Yes No License Type Transaction Type Fee Type Master Dup Date Fee 21 OFF SALE GENERAL STOCK TRANSFER MULTPLE N A y o 0311 0 07 Tota 124 00 124 00 Have you ever been convicted of a feony No Have you ever vioated any provisions of the Acohoic Beverage Contro Act or Department pertaining to the Act No Expain any Yes answer to the above questions on an attachment which sha be deemed part of this appication reguations of the a Appicant agrees that any manager empoyed in an on sae icensed premise wi have a the quaifications of a icensee and b that he wi not vioate or cause or permit to be vioated any of the provisions of the Acohoic Beverage Contro Act STATE OF CALFORNA County of SANTA CLARA Date March 10 2007 Under penaty of perjury each person whose signature appears beow certifies and says He is an appicant or one of the appicants or an executive officer of the appicant corporation named in the foregoing appication duy authorized to make this appication on its behaf 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 appicant or appicants has any direct or indirect interest in the appicant or appicant s business to be conducted under the icense s for which this appication is made 4 that the transfer appication or proposed transfer is not made to satisfy the payment of a oan or to fufi an agreement entered into more than ninety 90 days preceding the day on which the transfer appication is fied with the Department or to gain or estabish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor 5 that the transfer appication may be withdrawn by either the appicant or the icensee with no resuting iabiity to the Department Appicant Name s LUCKY STORES NC Appicant Signature s c 3 2
r State of Caifornia A PPLCA TON SGNATU RE SHEET SGN ON Department of Acohoic Beverage Contro This form is to be used as the signature page for appications not signed in the District Office Read instructions on reverse before competing A signatures must be notarized in accordance with aws of the State where signed 1 OWNERSHP TYPE Check one D Soe Owner o Partnership D Husband Wife D Partnership Ltd 2 FLE NUMBER i any 3 LCENSE TYPE 4 TRANSACTON TYPE 5 APPLCANT S NAME Last firs midde LUCKY STORES NC 6 APPLCANTS MALNG ADDRESS Sreet addressp 0 box city sae Zip code 800 STANDFORD AVENUE MODESTO CALFORNA 95350 21 D Origina D Exchange 2 Corporation D Limited Liabiity Company D Other D Person to Person Transfer D Premise to Premise Transfer 2 Other STOCK TRANSFER 7 PREMSES ADDRESS Sreet address city zip code v VAROUS LOCATONS APPLCANT S Under penaty of perjury each person whose signature appears beow certifies and says He She is an appicant or one of the appicants or an executive officer of the appicant corporation named in the foregoing ap Qication duy authorized to make this appication on its behaf 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 appicant or appicants has any direct or indirect interest in the appicant or appicant s business to be conducted under the icense s for which this appication is made 4 that the transfer appication or proposed transfer is not made to a satisfy the SOLE OWNER 8 PRNTED NAME Last first midde PARTNERSHP LMTED PARTNERSHP GNATURE CERTFCA TON payment of a oan or 0 fufi an agreement entered into more than ninety 90 days preceding the day on which the transfer appication is fied with the Departmen b to gain or estabish a preference to or for any creditor or transeror or c 0 defraud or mjure any creditor or transferor 5 that the transfer appication may be withdrawn by either the appicant or the icensee with no resuting iabiity to the Department understand that if fai to quaify for the icense or withdraw this appication there wi be a service cfiarge of one fourth of the icense fee paid up to 00 Signatures of genera partners ony DA TE SGNED 9 PARTNER S PRNTED NAME Las firs midde SGNATURE DATE SGNED PARTNER S PRNTED NAME Last first midde SGNATURE DATE SGNED PARTNER S PRNTED NAME Last first midde SGNATURE DATE SGNED CORPORA TON 10 PRNTED NAME Last first midde VC i q ei Sf J e TTLE D President DA TE SGNED TTLE D Secretary D Asst Secretary Q Chief Financia Officer 0 Asst Treasurer LMTED LABLTY COMPANY 11 The im ited iabiity company is member run D Yes DNa f no compete tem 12 beow 12 NAME OF DESGNATED MANAGER MANAGNG MEMBER OR DESGNATED OFFCER Las frs midde ABC NTALS DATE ABC useony 13 MEMBER S PRNTED NAME Las ist midde SGNATURE DATE SGNED MEMBER S PRNTED NAME Last St midde SGNATURE DATE SG ED ABC 211 SG 2 03 SGN ON 98 3
y M OR CALFORNA ALL PURPOSE ACKNOWLEDGMENT No 5907 e 2288 @ State of County of Ca ifornia stanisaus On 1 J 7 0 7 DATE personay appeared J personay known to me before me Phra K Keeer Ron Riesenbeck NAME TTLEOF OFFCER EG JANE DOE NOTARY PUBLC NAME S OF SGNER S 0 proved to me on the basis of satisfactory evidence to be th e pe rson whose n am e 91 i s ar e subscribed to the within instrument and ac t DEBRA K KEE LER acommission 1705206 Notary Pubic Caifornia Stanisaus County Myecmn Exp e ec10 2010 knowedged to me that he heiibay executed the same in hish er r authorized capacityue and that by his hera 1r signature SJ on the instrument the person or the entity upon behaf of which the person s1 acted executed the instrument WTNESS my hand and officia sea J Lt SGNATURE OF NOTARY OPTONAL Though the data beow is not required by aw frauduent reattachment of this forij it may prove vauabe to persons reying on the document and coud prevent CAPACTY CLAMED BY SGNER D NDVDUAL B CORPORATE OFFCER V p Cc TTLES DESCRPTON OF ATTACHED DOCUMENT U1j2 f U r TTLE OR TVPE OF DOCUMENT D PARTNER S o ATORNEY N FACT o TRUSTEE S o GUARDAN CONSERV ATOR o OTHER o LMTED D GENERAL NUMBER OF PAGES 2 C 0 7 DATE OF DOCUMENT SGNER S REPRESENTNG NAME OF PERSON S OR ENTTY ES 0 7 Uv1 J v S L ie V C k e b SGNER S OTHER THAN NAMED ABOVE @1993 NATONAL NOTARY ASSOCATON 8236 Remme Ave P O Box 7184 Canoga Park CA91309 7184 qb f
y y CALFORNA ALL PURPOSE ACKNOWLEDGMENT No 5907 State of c o cjc J fj Lc County On 1 of ALZj u personay appeared J Jb cjc7 before me J L r c c cv DATE tv C r rr NAME TTLE OF Of fcer E G JA DOE NOTAFY PUBLC S t U e v NAME S OF SGNER S f personay known to me OR 0 proved to me on the basis of satisfactory evidence to be the person s whose name is are subscribed to the within instrument and ac knowedged to me that he sbettwy executed the same in his bbr teir authorized ty DEBRA K KEELER Commission 1705206 Notary Pubic Caifornia Stanisaus County O O f j capacity te s and that by signature his h ir on the instrument the person sj or the entity upon behaf of which the person acted executed the instrument WTNESS my hand and officia sea o f Lt SGNATURE OF NOTARY k OPTONAL L Though the data beow is not required by aw it may prove vauabe to persons reying on the document and coud prevent frauduent reattachment of this form CAPACTY CLAMED BY SGNER o NDVDUAL E CORPORATE OFFCER U P fa V C V 2 e sc VCr TTLE S DESCRPTON OF ATTACHED DOCUMENT Lf D L 1 t r TTLE OR TYPE OF DOCUMENT o PARTNER S o LMTED o GENERAL o ATORNEY N FACT o TRUSTEE S o GUARDAN CONSERVATOR o OTHER t f 9 107 NUMBER OF PAGES DATE OF DOCUMENT SGNER S REPRESENTNG NAvE OF PERSON S OR ENTTY ES Sq e U 0 S 1 py VV7v L J7 SGNER S OTHER THAN NAv1ED ABOVE 98 5 91993 NATONAL NOTARY ASSOCATON 8236 Remme Ave PO Box 7184 Canoga Park CA 91309 7184