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HomeMy WebLinkAbout20140722_Application for ABC,• , Department of Alcoholic Beverage ,ntrol State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 21l (6/99) TO: Department of Alcoholic Beverage Control 605 W. SANTA ANA BLVD. BLDG 28, STE 369 File Number: 547078 Receipt Number: 2242939 Geographical Code: 3013 SANTA ANA, CA 92701 Copies Mailed Date: July 17, 2014 (714) 558-4101 DISTRICT SERVING LOCATION: First Owner: Name of Business: Location of Business: Issued Date: SANTAANA GRILL CONCEPTS CD, INC. RITZ RESTAURANT THE coMMUNITV Jlll ?, 2 '1.0\4 2801 W PACIFIC COAST HWY NEWPORT BEACH, CA 92663 DEVELOPMENT c; C} ~"x"' County: ls Premise inside city limits? Mailing Address: (If different from ORANGE Yes 6300 CANOGA A VE STE 600 .,.J--'<> Of' oa.?-"-Census Tract (1©'1,,,-., premises address) WOODLAND HILLS, CA 91367-8022 Type oflicense(s): 47 Transferor's license/name: 391024 / CHLN INC License Type Transaction Type 47 -On-Sale General Eating ANNUAL FEE Fee Type P40 47-On-Sale General Eating PERSON-TO-PERSON TRANSFER P40 Have you ever been convicted of a felony? No Master y y Dropping Partner: Yes Dup Date Fee 0 07/17/14 $876.00 0 07/17/14 $1,250.00 Total $2,126.00 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. NoL 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 ORANGE Date: July 14, 2014 Under penalty of perjury, each person whose signature appears below, certifies and says: (l) 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 l).nder 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 1, 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 licensee's name appears in the 500 largest tax delinquencies list. (Business and Professions Code Section 494.5.) Applicant Name(s) GRILL CONCEPTS CD, INC. Applicant Signature(s) See 211 Signature Page State of California Department of Alcoholic Beverage Control APPLICATION SIGNATURE 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 Jaws of the State where signed. 1. 0 ,, ..... R .... , ,,PT,, ... {1,.;heck one) OsoleOwner 0Partnership D Partnership-Ltd II] Corporation D Married Couple D Domestic Partner D Limited Liability Company Oother 2. FILE NUMBER (If any) 3. LICENSE TYPE Gt/7[)7.f 4. TRANSACTION TYPE Ooriginal [I Person to Person Transfer D Premise to Premise Transfer Oother 47 0Exchange 5. APPLICANT(S) NAME (Last, first, middle) Grill Concepts CD, Inc. 6. APPLICANT'S MAILING ADDRESS (Slreetaddress/P.O. box, city, state, zip code) 6300 Canoga Avenue Suite 600 Woodland Hills CA 91367 7. PREMISES ADDRESS (Street address, city, zip code) 2801 W. Pacific Coast Highway Newport Beach CA 92663 APPLICANT'S CERTIFICATION 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 application, 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 SOLE OWNER 8. PRINTED NAME (Last, first, middle) SIGNATURE X 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, (b) to gain or establish a preference to or for any creditor or transferor, or ( c ) to defraud or injure 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. DATE SIGNED PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only) 9. PARTNER'S PRINTED NAME (Last, first, middle) PARTNER'S PRINTED NAME (Last, first, middle} PARTNER'S PRINTED NAME (Last, first, middle) CORPORATION 10. PRINTED NAME (Last, first, middle) Spivak, Robert Lee TITLE [i President Dvice President D Chairman of the Board PRINTED NAME (Last, first, mJddle) Bayley, John Bland TITLE Osecretary 0Asst. Secretary [I Chief Financial Officer LIMITED LIABILITY COMPANY 11. The limited liability company is member-run SIGNATURE X SIGNATURE X SIGNATURE X Oves 12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle) 13. MEMBER'S PRINTED NAME (Last, first, middle) SIGNATURE X . MEMBER'S PRINTED NAME (Last, first, middl~) S\GNATURE X ABC-211-SIG (2109) "SIGN ON" DATE SIGNED DATE SIGNED DATE SIGNED DATESIG ED ei· JO (If no, complete Item #12 below) DATE SIGNED RECEIVED DATE SIGNED JUN 1 2 2QH Dept. of Alcohohc lkvornge Control Santa Arm Office ·