ABC License Form - Be.Steak.A LLC - Dec 2018 •
•
Department 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: 598527
100 PASEO DE SAN ANTONIO Receipt Number: 2543744
ROOM 119 Geographical Code: 4302
SAN JOSE, CA 95113 Copies Mailed Date: December 7,2018 .
(408)277-1200 • Issued Date:
DISTRICT SERVING LOCATION: SAN JOSE •
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ip
First Owner: BE.STEAK.A LLC GEC ;
•
Name of Business: ORCHARD CITY KITCHEN Citl 2018
Location of Business: 1875 S BASCOIVI AVE. Clay A o GE MPgc�L
STE 190 A R S OFF�CF
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CAMPBELL, CA 95008
County: SANTA CLARA
- Is Premise inside city limits? Yes Census Tract 5026.04
Mailing Address:
(If different from •
premises address)
Type of license(s): 47
Transferor's license/name: Dropping Partner: Yes No
License Type. Transaction Type Fee Type Master Dup Date Fee
47-On-Sale General Eating ORIGINAL FEES NA 1" 0 .09/20/18 $15,384.00
47-On-Sale General Eating ANNUAL FEE P40 Y 0 12r'07/18 S 1,010.00
• Total $16,394.00
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 premises 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: September 20, 2018
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.
Effective July I,2012,Revenue and Taxation Code Section 7057,authorizes the State Board of Equalization and the Franchise Tax Board to
share taxpayer information with Department of Alcoholic Beverage Control.The Department may suspend,revoke,and refuse to issue a license
if the Iicensee;,s name appears in the 500 largest tax delinquencies list.(Business and Professions Code Section 494.5.)
Applicant Name(s) Applicant Signature(s) •
See 211 Signature Page
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BE.STEAK.A LLC •
State ai,California Department of Alcoholic Beverage Control
APPLICATION SIGNATURE SHEET ("SIGN ON')
1. OWNERSHIP IYPE(Check one)
• This form is to be used as the signature page for
applications not signed in the District Office. �isole Owner !Partnership Ltd
• Read instructions on reverse before completing. Partnership I 'Corporation
• All signatures must be notarized in accordance !Married Couple dLimited Liability Company
with laws of the State where signed.
Domestic Partner Other
2. FILE NUMBER(If any) 3. LICENSE TYPE 4. TRANSACTION TYPE
II:Original f!Person to Person Transfer
Exchange Premise to Premise Transfer
47 • *other Priority
5. APPUCANT(S)NAME(Last,first,middle) .
Be.Steak.A LLC •
6. APPLICANT'S MAILING ADDRESS(Street address/P.O.box,city,state,zip code)
1875 S.Bascom Ave. Ste. 190,Campbell,CA 95008 •
7. PREMISES ADDRESS(Street address,city,zip code)
1875 S. Bascom Ave. Ste. 190, Campbell, CA 95008
APPLICANT'S CERTIFICATION
Under penalty of perjury,each person whose signature appears ! payment of a loan or to fulfill an agreement entered into more than
below,certifies and says: (I)He/She is an applicant,or one of ninety(90)days 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 application,duly authorized preference to or for any creditor or transferor,or(c)to defraud or
to make this application on its behalf;(2)that he/she has read the injure any creditor or transferor;(5)that the transfer application
foregoing and knows the contents thereof and that each of the j may be withdrawn by either the applicant or the licensee with no
above statements therein made are true;(3)that no person other I resulting liability to the Department.
than the applicant or applicants has any direct or indirect interest I understand that if I fail to qualify for the license or withdraw
in the applicant or applicant's business to be conducted under the this application there will be a service charge of one-fourth of the
license(s)for which this application is made;(4)that the transfer license fee paid,up to$100.
SOLE OWNER
8. PRINTED NAME(Last,first,middle) SIGNATURE DATE SIGNED
X
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
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 DATE SIGNED
X •
CORPORATION
10. PRINTED NAME(Last,first,middle) SIGNATURE DATE SIGNED
IX
TITLE
President Vice President I (Chairman of the Board
PRINTED NAME(Last,first,middle) SIGNATURE DATE SIGNED
X
TITLE
Secretary I lAsst.Secretary Chief Financial Officer Asst.Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member-run Yes 111 No (If no,complete Item#12 below)
12. NAME OF DESIGNATED MANAGER,MANAGING MEMBER OR DESIGNATED OFFICER(Last,first,middle)
Jeffrey Leigh Stout
13. MEMBER'S PRINTED NAME(Last,first,middle) SIGNA DATE SIGNED Jeffrey Leigh Stout • X ' `0—Z 9-2 01 f
MEMBER'S PRINTED NAME(Last,first,middle) SIGNf , !DATE SIGNED
XV '-
ABC-211-SIG (2/09) "SIGN ON" 1 u �� �` -1 '0N ML®k\' 174' YL
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