HomeMy WebLinkAbout02-Public Works
"'"
~~COpy h_____."....
---
- . ... .0",
APPUCATION FOR ALCOHOUC BlVERAGE UCEN5E(5) 1. TYPE(S) OF lICENSE(S) FILE NO.
- ....-
To: Department of Alcoholic Beverage Control RECEIPT NO.
1901 Broadway OFF SALE BEER & WINE 270183
Sacramento, Calif. 95818 San Bernardino GEOGRAPHICAL
to,.T..C" ..IIVING LOCATION. CODE '''Ir.
.-
- The undersigned ltereby opplie. fDt
Date
licen.e. described o. """'w.: ~ .- Issued
2. N~E(S) OF APPLICANT(S) or ., Temp. Permit
.~ Applied uncler See. 2~ 0
CLULid, G-eorqe D. Effecti.. Date. 1/1/85 Effective Dcrte:
. 3. TYPE(S) OF TRANSACTION(S) FEE LIC.
.
. TYPE
.. - $ 100.QO
,..... New . . 20
. -
Annua 1 F~e 28.00
-
- -~~'
. .- ~
.
4. Nome of 8usin_ I' n
1J.,..,"'\r~ " ..~ ~ ?\;;\ -~- CT 49 rrr
c ~ <:
5- Location of Business-Number ancl Street - .:; "
0
r .) }~
,)..i 101 ft. Mt.. Vernon -t
- .. -<
-
City ancl Zip Cade _ County ~$ 1i's.OO
e- , "~,,,,"i ~~ a~/c1(\ 'b~ ;.,~--- r,~",in TOTAL ~ .
-.
.. Hot Wri.. ..... fltl. u..-..
H...,. _
Ollie
6. If Premls.. LIcensed,
Show Type af license ______
8. Mailing Addr_ (if different fram 5)-Number ancl Street
7. Are Premiws Inside
City Limits?
,
Yas
(1.".,,1 (~"MJ
9. Have y~u ever been convicted of a felDl1y?
Pern,
10. Have you ever violated any of the provisions of the Alcaholic
Beverage Control Act or regulations of the Department per.
// ,) taining to the Act? /' i -
Explai~. ~ '~~~:'_ ~:swer to ita";' 9 or lOon on o"achment which sholl be deemed part of this application.
~~;;"1.o
11.
12.. Applicantagrees (a) that anymar,ager-employeCtin on-sale licinsed premises will have all tnequaunconons-.oT o-_II"'.:I"~_"'''''''''''~__-'
(b) that he will not violate or cause or permit to be violated any of the provision. of the Alcoholic Beverage 'Control Ad.
County 'of .____~l?-'Lt'_f;;.f'J}Ar q1--GQ__________ Date ______!.Q.LL11~?________,
I
13. STATE OF CALIFORNIA .
Undw penalty of peri"'y. eoch pelton whow .ig_tvr. oppee.r. betow. 'c.,tifie. 0,", MI"': (1) H. i. the opplicont. or _ of tM opplico"',, or _ .aec"ti....
0.... of the opplicollt corpCIII'otion. __d i" .th. for..ing opplicotio". duly outhoriJed to molee thl. opplico.ion 0" its IMholf; (21 thot he' hot ,eed the fort:-
eoing opplication a"d "flOW.. the conteft" ~f and that each ond 011-' of the .to...-"" theNi" mode 0'. I,.".; (J) that fIO p.nOfl oth... than .... appIieon'
or applicant. hot 0",. di.... 01" indi,ect i"..,..t In ,he appIico,,'" or opplican'.' bwl5i_.. to IN condvded und... the IiCeftM(.) fOl" which this opplicatiOfl i, _d.;
(4) tho, the tro"".r opplico,i_ Dr prltpClltM tron"... i. ftOt mode to IOti"y the poy_'" of 0 100" or to fulfill 0" ..r.._tIt eft'."'" into _. tho" nin..,. (90)
doy. pt".ceding the do, DfI which the tron,f... opplication i. filed with the - Depo,t","t or '0 gain or .,'obli,h 0 pr.ferefIC. '0 or for on,. crMitor of tro"".'OI" Of' to
defrovd or i"j"r. any creditor of tran"_; (5) tho' the t,o".f... opplication may be withdrawn by .i'he, the opplicont or the licenwo wi'h "0 ro",hing lie-bility to
tho Depo,ltMn'.
1... APPLICANT .
SIGN HERE ,~~----=;"-~--""----;~"-------"C--e~"?------
----------~-----~-----------~-------------------~----------,
je
-----------------------------------------------------., .
._---------------~----------------------------------~------.
APPLICATION BY TRANSFEROR
.15. STATE OF CALIFORNIA
County of _____________________________________ Date ------_____________________
UneJ.,: petloh, of perj.....,. _h p.r1Dft wh... tignotvr. OPfNCII" below. c.rtifi.. ~rtd MI'" II) H. i, the Iic.n,... or on ...evtiv. DIRe., of tt,. corporo.. lie_....
.....".;..~ ;i. ,;.. f~:~.....::,. !P:!"~f=~ '?:",~!k",';l:I'''''. ~ul,. outhllri"led to ",ok. this 'ron.fM application _ it. IMholf; (2} that No her.b, fI'MI.... opplieotio" to _,.nd.,
on in,.,..t i'" tho ottochecl lic.n..(.) cIoKribed boIow ond to tronlf... 10"'. to tho opplicont ond:or laeolion indicated on tho \lppof' peN'ion of this appltcotioft
form. if t:..ch tronaf... i. opprov'" b, tho Director: (3) that the Iran..... application or Pf'opo.ed fro".f... i.. ftOt fl'MlcIo to IOtid,. ,h. po,men' of 0 loon or 10 f"lfill
0" OW....,...., .....,ed Into _ thon nlnetp cloy. prec.... the do,. on which the tro"d., oppUcoti_ i. filed with the o.po"",_'" or to ..in or ..toblith a
p'......nc. to or for on,. creditor 01 trond.,., or to cIofroud or iniur. a'" c,.ditCH' of Iton.f.rCH': (41 ,hot tho .......f... o,.lico'iOft mey be wilhcl,.w" by eit..... th.
opplit;o'" or the Ik__ with. ftO ro."ltiflO nobillt, to the Doportmefl';
16 Narne(.) of Licensee(s)
17 SIgnature(s) of Licensee(s)
18. Licen.e Number(.)
...
.
"
19. Location
Number and Street
City and Zip Cade
County
DoNot Write Below Thia Line; For Department Uae Only c-'"
\'lo<hed: 0 Recorded notice,
o Fiduciary papers, '
o ______-------------------------c------=--------~..,.,COPIES MAILED ...l.~.L!l.5...___]._ilL! ij L~2__________'
fOTM...1 '< -;...,. /)'.
o Renewal: Fee oL_______:..Paid al____________________________Oflice on__:~--~--~-----.Rec8ipl No. -----~--------~
. .,..., '-' -.- ~~3)Msm.._