27741 Crown Valley Parkway, Unit 221 N VICINITY MAP

27741 Crown Valley
Parkway, Unit 221
VICINITY MAP
252 ft
N
CItyGIS 6.0
Copyright @ 2006 All Rights Reserved. The information contained herein is the prorietaty propty of the
contributor supplied under license end mey not be apprcied eoept as licensed by Digital Map Products,
ATTACHMENT 2
Charles Wilson
City of Mission Viejo
Planning Commission
November 26, 2008
Letter of Intent,
Mr. Wilson,
My name is Dan Lauriano, I currently own and operate Riptide Rockin’ Sushi &
Teppan Grills located in the city Mission Viejo as well as CHOMP located in the city of
Fullerton, CA. I am writing you this letter to inform you and the Commission of my
intent to open “The Derby” Deli & Dueling Piano Bar inside the Kaleidoscope Center in
Mission Viejo. First let me explain what The Derby is all about:
(Copiedfrom our Press Release)
From Rockin’ Restaurants Inc. comes a most unique upscale entertainment
themed restaurant in the form of “The Derby Deli & Dueling Piano Bar”. This
nostalgic eatery will transport you back to a New York City era long gone by. Located in
Mission Viejo inside the beautiful Kaleidoscope Shopping Center which houses such
famous establishments as The Regal 10 Theaters, Bristol Farms, Burke Williams Spa, El
Torito Grill, Islands Restaurant, Howie ‘s Game Shack and Rockin’ Restaurants’ own
Riptide Rockin’ Sushi & Teppan Grills. The Derby Deli & Dueling Piano Bar is a
classic New York style delicatessen, which blends the traditional Jewish & Italian deli
cuisine. Whether it’s brining, curing or pickling, The Derby preps, slow cooks & smokes
choice cuts of meats and cheeses. No processed or precooked meats. Our daily promise:
“No Cold Corned Beef or Pastrami!” If it’s truly fresh... it’s hot!
The Derby will offer traditional deli featuring “Super Stacked” 1 Ooz. sandwiches on
fresh baked breads, traditional salads, soups and select appetizers. At over 7000 square
feet with a courtyard front, open-air patio and a beautiful private lounge known as “The
Back Lot” which over-looks San Juan Capistrano Hills. “The Back Lot” features full
dining & cocktail service plus live video feeds of the famous Dueling Piano Show
performing in the main room. The Derby Deli & Dueling Piano Bar is a nostalgic New
York style eatery that will be the perfect spot for that business lunch, fun date, or a stylish
big party celebration.
ATTACHMENT 3
The Main Room at The Derby is where all the action is. Affectionately called
“Center Stage”, the room centers around two Baby Grand Pianos where piano men (and
women) battle it out for Derby supremacy nightly. It’s one side of the room against the
other to see who can sing, clap, play tambourine, limbo or hula-hoop their way to The
Derby’s nightly crowned winning side! If your are hoping to hear Frank Sinatra, Elvis
Presley, The Beatles, Billy Joel, Elton John, The Village People, Queen, Depeche Mode,
Michael Jackson, Madonna, Nirvana, Snoop Dogg, Guns & Roses, Garth Brooks, The
Killers, Coldplay, The Pussycat Dolls and virtually everything in-between, not only in
one place, but in one night, The Derby is for you! If the song is serious, you can rest
assured knowing that our entertainers will change a few words around and make the song
not quite so serious. Our Piano Players take requests nightly. Knowing 1000’s of songs,
they can rarely be stumped, but give it a shot! Large parties are The Derby’s specialty.
Whether privacy is needed or you prefer a front and center seat to the craziest show
around, The Derby can accommodate groups up to 100 nightly.
The Derby also features a full cocktail bar with an unmatched martini list and
several beers on draft. The Deli opens at 11am daily and remains open with full menu
until 2am. If you have been searching for the perfect New York style delicatessen,
amazing Martinis, The Greatest Piano Show On Earth, and a time machine... The Derby
Deli & Dueling Piano Bar is it.
The lease space was formerly Chin Chin, Anapuma Garden & two separate
operators tried to make a go of things as Versachee. The space is now vacant. I have
leased the Versachee space and the adjoining space and will open both sides up as this
new concept. The Landlord has formally combined both suites that will share one
address.
The building modifications are as follows:
1. Due to the insufficient facilities currently present, the space will be outfitted with
new ADA compliant Men’s & Women’s Restrooms.
2. The patio is being extended an additional four to six feet in areas and a three-foot
valance is being installed above the gated perimeter with hanging slide-able vinyl
curtains that can enclose patio seating during inclement weather. (See elevation)
3. The storefront on the Versachee side will be removed so that the two pianos can
be centrally located in the main room, which is essential to the concept’s success.
4. The bar, which is afready in place, will be modified to accommodate locking
systems for all alcohol when the restaurant is closed.
5. The Kitchen entry/exits will all be ouffitted with locking doors
6. Synthetic water-proof wood flooring installed throughout the restaurant
7. Ceiling fans installed throughout the main room to increase circulation
8. Drop ceiling removed in places to enhance main room acoustics.
9. Arched Lucite (clear) Double Doors will be installed to combine the two suites
a) This provides the benefit of allowing people to enjoy the Deli in “The
Back Lot” without being subject to the volume of the Dueling Piano Show
and also protects Islands Restaurant from volume issues during there
dining hours.
10. New ADT alarm system throughout the restaurant with multiple motion sensors in
the main room.
a) The Kaleidoscope has hired a new security company recently (Securitas)
that actually does a great job of patrolling the facility 24 hours a day but
with only having vinyl to breach in the way of a storefront, I want to be
alerted to any interior motion immediately.
b) The only items that will be readily available to steal if someone were to
break in would be the tables and chairs and the pianos (hard to imagine
security not hearing an audible alarm in a courtyard or seeing a burglar
making off with a piano!) Virtually Everything will be locked up at night.
My General Liability Insurance Carrier is aware of my conceptual plans
for The Derby. They have written a standard policy as a result of my
security plan.
I am requesting from the commission that they consider simply modifying the existing
Versachee C.U.P. to include considerations for the new Derby concept. I am in process
with the A.B.C. with a new 47 On-Sale General Liquor License that obviously needs the
Planning Commission’s blessing. If a new C.U.P. is required, I ask if the process could
please be an expeditious one as my lease space build out should not be an extended
venture. Please contact me at (714) 943-1096 for any questions.
Thank You,
Dan Lauriano
CEO
Rockin’ Restaurants Inc.
Riptide Restaurants Inc.
West Derby Restaurants Inc.
21141 Crowii Valley Pkwy. t221 Mission Viejo, CA 92692
Derby Facts
Corporate:
West Derby Restaurants Inc.
DBA “The Derby Delicatessen & Dueling Piano Bar”
Address:
27741 Crown Valley Pkwy #221
Mission Viejo, CA 92691
Square Footage:
6332 sq ft.
Cuisine:
Italian & Jewish Delicatessen
New York Style Eatery featuring Derby Expertise, “All baking
done fresh daily and we cure, pickle and smoke our own fresh
meats in our own commissary”. Soups, Salads, Deli, Egg Dishes,
Gourmet Burgers, Cheesecakes, Cannolis and more!
Entertainment:
Dueling Piano Show Two Piano Players face off nightly playing
standard hits from the 1950’s thru 2000’s. Crowd participation is
constant in this “Duel”. Very fun gathering spot for couples or
large groups.
Hours of Operation:
11:30am to 2:00am
Full Menu available 11 :3Oam’til 11pm, extensive “Night Owl”
menu available including Deli sandwiches available from 11pm to
1:30am nightly
—
Dueling Piano Show Tuesday Through Thursday 9pm 1 :3Oam
Friday & Saturday
7pm 10pm &
11pm— 1:30am
—
—
Service of Alcohol:
47 On Sale General License
Beer, Wine and Spirits will be offered at all hours of operation
Security:
One security guard will be staffed nightly to work at the entrance
Host’s stand. His responsibilities will be to check ID’s and enforce
the Dress Code nightly. Disruptive behavior will not be tolerated at
The Derby.
Admission Fee:
A $5.00 per person fee will be charged for all guests seated in the
main room named “Center Stage” during the hours of live
entertainment. No fee will apply to those guests who wish to dine
in the “Back Lot Lounge” which serves the same menu and will
remain open during all hours of operation.
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Cily of Mission Viejo
Planning Application
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PROffiRIY OWNER OF RECORD DATE
AUTHOtUZED AGENT DATE
OPPICE US ONLY
APPROVALS AI’4D ACTIONS
Previous Related Items:
FOR
This Appliéadon:
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The Derby
Kaleidoscope Center Mall, Level #5
27741 Crown Valley Pkwy #221
Mission Viejo, CA 92692
Contact: Dan Lauriano
(714) 943-1096
Deli & Dueling Piano Bar
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Email from Lt. Stephan Bernardi (Police Chief) of Mission Viejo Police Service
commenting on the proposed project will be forwarded separately
S
Public Services Comments
The Derby
27741 Crown Valley Parkway
2-4-09
The applicant shall submit and landscape plan for the out door dining area
the plan shall include the following
-
-
-
-
list of plant material in each container
size, quantity, botanical name, common name
List of irrigation equipment to be used to automatically irrigate the
containers
Catalog cuts of the pottery
Catalog cuts of the patio furniture
ATTACHMENT 7
City of Mission Viejo
Memorandum
Date:
January 29, 2009
To:
Tim Martin, Associate Planner
From:
Joe Ames, Associate Civil Engineer
Subject:
CUP 2008-272, The Derby
—
Dueling Piano Bar & Delicatessen
APPLI CANT:
Dan Lauriano
LOCATION:
27741 Crown Valley Parkway, Suite 221
BELOW ARE CONDITIONS FOR THE SUBJECT APPLICATION FROM THE PUBLIC WORKS
DEPARTMENT:
1. Provided that no major exterior improvements to the building or the property are being
proposed, the Public Works Department has no comments.
ATTACHMENT 8
MEMORANDUM
Date:
1-30-09
To:
Tim Martin, Associate Planner
From:
Dennis Bogle, Building Official
Subject: CUP 2008-272
The Derby
27741 Crown Valley, Suite 221
This project appears to be feasible from a building code perspective. Plans will need
to be submitted to Building Services for review prior to issuance of a building
permit. Building permits will be required for any modifications to the suite.
ATTACHMENT 9
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O2-0309
09:27 AM
SflNTR NR
714 953 4486
CENSUS TRACT INFOMATION BY CENSUS TRACT WITH ADDRESS
WHERE COUNTY IS 30-ORANGE AND CENSUS TRACT IS 032013
Census
Ucense
Num
Licensee
Premises
PAGE; 1
Types
Status
0320,13
47
ACT
431993
BLUESEVENRESTAURANTGROLJPINC
27567 PUERTA REAL, MISSION VIEJO CA 92691-5321
0320.13
47
ACT
111060
MISSIONVIEJOCOUNTRYCLU8
26200 COUNTRY CLUB DR. MISSION VIEJO CA 92691
0320.13
47
ACT
298363
BRINKER RESTAURANT CORPORATION
27407 SELLOGENTE, MISSION VIEJO CA 92691
0320.13
20
ACT
413525
CROWN VALLEY76LLC
26411 CROWN VALLEY PKWY, MISSION VIEJO CA 92691
0320,13
21 41
ACT
337507
BRISTOL FARMS
27741 CROWN VALLEY PKWY Ml, MISSION VIEJO CA 92691
0320.13
47
965
338834
ELTORITORESTAURANTSINC
27741 CROWN VALLEY PKWY T2, MISSION VIEJO CA 92691
0320.13
47
ACT
344593
Tract
—
-
-___________
ISLANDSXILLC
27741 CROWN VALLEY PKWY P15, MISSION VIEJO CA
0320.13
47
ACT
427499
92691
AIPTIDERESTAURANTSINC
27741 CROWN VALLEY PKWY, MISSION VIEJO CA 92691
0320.13
20
ACT
469933
JAHADUMIOILINC
0320.13
20
ACT
355678
CHEVRONSTATIONSINC
26302 OSO PKWY, MISSION VIEJO CA 92691
0320,13
47
965
441957
0320.13
20 41
ACT
432635
NGUYENKIMGUONGTHI
27741 CROWN VALLEY PKWY, MISSION VIEJO CA 926916598
WINORKS INC
26342 OSO PKWY, MISSION VIEJO CA 92691-5646
0320.13
47
PEND
470588
26282 OSO PKWY, MISSION VIEJO CA 92691-5640
LAURIANODANIELJAMES
27741 CROWN VALLEY PKWY, MISSION VIEJO CA 928916598
ATTACHMENT 10
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714 953 4496
CENSUS TRACT INFORMATION BY CENSUS TRACT NUMBER
where couniy Is 30-ORANGE nd census tract is 032013
02-03-09
09:31 AM
TOTAL: 1 3
Off Sale
Active
Oil Sale
Perid
Census
Tract
DO
30
0320.13
11
431993
Y
N
N
N
30
0320.13
11
111060
Y
N
N
N
30
0320.13
11
298363
Y
N
N
N
30
0320.13
11
337507
Y
N
Y
N
30
0320.13
ii
338834
V
N
N
N
30
0320.13
11
344593
V
N
N
N
30
0320.13
11
355678
N
N
Y
N
30
0320.13
11
413525
N
N
V
N
30
0320.13
11
427499
Y
N
N
N
30
0320.13
11
432685
V
N
Y
N
30
0320.13
11
441957
V
N
N
N
30
0320.13
11
469933
N
N
Y
N
30
0320.13
11
470588
N
V
N
N
9
1
5
0
courrrv
License Num
Totals
On Sale
Active
P.2
On Sale
Pend
TflTI
P L2
CENSUS TRACT 320.13
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SUBJECYT SITE
ATTACHMENT 11
RESOLUTION 2006-1028
A RESOLUTION OF THE CITY OF MISSION VIEJO PLANNING AND
TRANSPORTATION
COMMISSION
APPROVING
MINOR
MODIFICATION MM2006-118, SUBMITTED BY ANGELA NIAZI OF
VERSACHEE ITALIAN RESTAIJRANT TO MODIFY PREVIOUSLY
APPROVED
CONDITIONAL
PERMIT
USE
CIJP2003-195
IN
CONJUNCTION
THE
WITH
EXISTING
RESTAURANT
AT
KALEIDOSCOPE, 27741 CROWN VALLEY PARKWAY, IN THE CH
(COMMERCIAL HIGHWAY) ZONE. THE PREVIOUSLY APPROVED
CONDITIONAL USE PERMIT PERMITTED THE ON-SITE SALE OF BEER
AND WINE, AND THE PROPOSED MODIFICATION IS TO PERMIT THE
ON-SITE SALE OF DISTILLED SPIRITS AT THE RESTAURANT.
WHEREAS, Minor Modification MM2006-1 18 was filed by Angela Niazi of Versachee
Italian Restaurant, in accordance with the provisions of the City of Mission Viejo Municipal Code;
and
WHEREAS, Minor Modification MM2006-118 was processed in the time and manner
prescribed by state and local law; and
WHEREAS, the Planning and Transportation Commission conducted a noticed public
hearing on April 10, 2006, at which time interested persons had an opportunity to testify either in
support or opposition.
NOW, THEREFORE, THE PLANNING AND TRANSPORTATION COMMISSION OF
THE CITY OF MISSION VIEJO DOES HEREBY RESOLVE, DETERMINE AND ORDER AS
FOLLOWS:
SECTION 1- FINDINGS
That the City of Mission Viejo Planning and Transportation Commission hereby makes the
following findings:
1.
That the proposed use is consistent with the City of Mission Viejo General Plan.
2.
That the proposed use is conditionally permitted within the CH (Commercial Highway)
zoning district and complies with all of the applicable provisions of the City of Mission
Viejo Development Code.
3.
That the location, size, design, and operating characteristics of the proposed use are
compatible with existing and known future uses and will not create significant noise, traffic,
or other conditions or situations that may be objectionable or detrimental to other permitted
ATTACHMENT 12
MM2006-1 18
Page 2
uses in the vicinity or adverse to the public interest, health, safety, convenience, or welfare of
the City.
4.
That the proposed use will not impair the integrity or character of the CH (Commercial
Highway) zoning district in which is it located.
5.
That the subject site is physically suitable for the type and intensity of use being proposed.
6.
That there are adequate provisions for water, sanitation, and public utilities and services to
ensure that the proposed use will not be detrimental of public health and safety.
7.
That approval of the Conditional Use Permit for the proposed use is in compliance with the
requirements of the California Environmental Quality Act.
8.
That the Planning and Transportation Commission does not object to the issuance of an
alcoholic beverage license for the upgrade to the on-sale beer, wine and distilled spirits in
conjunction with a restaurant. The sale of beer, wine, and distilled spirits shall be for on-site
consumption only.
9.
That the data and analysis upon which these findings of fact are based are set forth in staff
report for M1v12006-1 18, staff presentations, public testimony, and Commission comments
that constituted the Planning and Transportation Commissioners’ review of this application.
SECTION 2- ENVIRONMENTAL REVIEW
The Community Development Department staff examined the proposal and determined that it is
categorically exempt from the provisions of the California Environmental Quality Act pursuant to
Section 15301 “Existing Facilities” of the CEQA Guidelines.
SECTION 3- CONDITIONS OF APPROVAL
That the City of Mission Viejo Planning and Transportation Commission hereby approves Minor
Modification MM2006-118 to permit the on-site sale of beer, wine, and distilled spirits in
conjunction with Versachee Italian Restaurant at 27741 Crown Valley Parkway, Suite 221,
Kaleidoscope, subject to the following conditions:
1.
That this approval constitutes approval of the proposed project only to the extent that the
project complies with the City of Mission Viejo Development Code and any other applicable
zoning regulations. Approval does not include any action or findings as to compliance or
approval of the project regarding any other applicable ordinance, regulation or requirement.
2.
That this approval is valid for a period of one year from the date of final determination. If
the use approved by this action is not established within such period of time, MM2006-118
shall expire unless upon written request by the applicant prior to the expiration date, an
extension is granted by the Planning and Transportation Commission.
MM2006-1 18
Page 3
3.
That except as otherwise provided herein, this permit is approved as a precise plan. After
any application has been approved, if changes are proposed regarding the location or
alteration of any use or structure, a changed plan may be submitted to the Director of
Community Development for approval. If the Director determines that the proposed change
complies with the provisions and the spirit and intent of the approval action, and that the
action would have been the same for the changed plan as for the approved plot plan, he may
approve the changed plan without requiring a new public hearing.
4.
That if the approved use is discontinued for 90 continuous days or an aggregate of 120 days
during any 365-day period, MM2006-118 shall automatically lapse and shall become null
and void.
5.
That all window signs, banners, pennants, A-frame signs, balloons, neon signs or other
freestanding signs, flashing or blinking lights, and flags (with the exception of the American
or California State flag on a stanchion not exceeding 20 feet in height) shall be prohibited at
all times except as otherwise permitted in a City approved sign program. No exposed neon
shall be located on the exterior portions of the building, including signage.
6.
That if, in the opinion of the Director of Community Development, an aspect of the
restaurant creates a nuisance, the property owner and applicant shall take measures to
eliminate the nuisance. For purposes of this condition, a nuisance includes, but is not limited
to, the following:
A.
B.
C.
D.
E.
F.
G.
H.
I.
7.
Building exterior, roof, landscaping, grounds, walls, fences, driveways, parking lot,
sidewalk, or walkway which are defective, hazardous, or unsightly;
Refuse placed so as to be visible from neighboring properties or streets;
Improperly maintained signs or illegal signs;
Occupancy exceeding limit set forth in the City’s Building Code, City’s Fire Code, or
this resolution, whichever limit is most stringent.
Lack of adequate ventilation, sanitation, or plumbing facilities, or a condition that
constitutes a fire hazard;
Loitering;
Parking congestion;
Overnight outside storage of vehicles;
Any other condition or practice declared by state, county, or City statute, code, or
regulation to be a public nuisance.
That the applicant shall maintain the premises in a clean and sanitary condition at all times.
A trash control policy shall be instituted by the applicant to ensure the prompt removal of
empty bottles, cans, and debris that may accumulate at the site. All trash, storage of cartons,
containers, and other discarded items shall be screened from public view at all times. The
applicant agrees to work with Waste Management to develop a recycling plan to include
MM2006-1 18
Page 4
employee training, and to utilize appropriate recycle containers.
8.
That the applicant shall obtain a “Type 47 On-Sale General” license from the State
Department of Alcoholic Beverage Control prior to the sale or consumption of distilled
spirits at the subject restaurant. The on-sale beer, wine and distilled spirits consumption shall
be only in conjunction with the sale and consumption of food and shall be conducted in
compliance with all State Department of Alcoholic Beverage Control rules and regulations.
The applicant acknowledges that use of the subject dining facility is a restaurant and that it
will not be converted to a bar. The sale of beer, wine and distilled spirits shall be for on-site
consumption only.
9.
That live entertainment, public dancing by patrons, or other uses not expressly permitted in
this resolution shall be subject to review and approval by the Planning and Transportation
Commission.
10.
That the proposed use shall meet the City’s interior and exterior noise standards. Further,
any amplification system shall be controlled so that the sound is confined to the interior of
the building.
11.
That the management of Versachee Italian Restaurant shall immediately report any incidents
involving unusual disturbances, physical injury! altercations, or unlawful conduct to the
Sheriff’s Department (City Police Department); copies of all incident reports shall be
submitted to the Sheriff’s Department on a monthly basis. Applicant shall educate its
management staff and employees of the need to report such incidents.
12.
That the restaurant hours of operation shall be limited to 11:00 a.m. to 1:00 a.m. and from
seven days a week unless longer hours are expressly authorized by the Director of
Community Development.
13.
That this approval excludes the rental of any portion of the subject lease space for a use not
authorized under this approval without express approval by the Planning and Transportation
Commission.
14.
That the applicant shall comply with all previous governmental approvals pertaining to the
property, including CUP2003-195, except where in conflict with the terms of this approval.
In the event of a conflict, the terms for this approval shall prevail.
15.
That on-sale beer, wine and distilled spirits operation shall be carried out in general
conformance with the site plan and floor plan, submitted by the applicant and marked Exhibit
“A” and dated April 10, 2006, for identification.
16.
That this approval is expressly granted to Angela Niazi of Versachee Italian Restaurant and is
not transferable unless and until the new owner/operator submits a letter to the City’s
-
MM2006-1 18
Page 5
Director of Community Development wherein said owner/operator states he has read,
understand, and agrees to the conditions of approval of Minor Modification MM2006-1 18.
17.
That this approval is contingent upon written acknowledgment from the property owner and
applicant indicating that they accept the benefits conferred by this approval subject to the
conditions imposed herein.
PASSED, APPROVED, AN]) ADOPTED THIS
th
10
DAY OF APRIL, 2006.
Neil F. Lonsinger, Chairman
Charles E. Wilson, Secretary
PROPERTY OWNER’S AND APPLICANT’S ACKNOWLEDGMENT
I have read, understand, and accept the conditions of approval set forth herein above in this.
resolution of approval for Minor Modification MM2006-1 18.
Date
Angela Niazi of Versachee Italian Restaurant, Applicant
Date
Officer, K.T. Kaleidoscope Inc., Property Owner
G:\WP\CD\currentplan\Tim\MM\MM2006- 11 8RES.doc
Department of Alcoholic Beverage Control
State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 21! (6/99)
-
TO: Department of Alcoholic Beverage Control
605 W. Santa Ana Blvd.
Bldg. 28, Ste. 369
Santa Ana, CA 92701
(714)558-4101
File Number:
470588
Receipt Number:
1695032
Geographical Code:
3027
Copies Mailed Date: December 19, 2008 ;
Issued Date:
DISTRICT SERVING LOCATION:
SANTA ANA
irst Owner:
LAURIANO DANIEL JAMES
Name of Business:
DERBY THE
Location of Business:
27741 CROWN VALLEY PKWY
STE 221
MISSION VIEJO, CA 92691-6598
County:
ORANGE
Is premise inside city limits?
Yes
Mailing Address:
(If different from
premises address)
181 E COMMONWEALTH AVE
FULLERTON, CA 92832
Type of license(s):
47
Transferor’s license/name:
L
License Type
Census Tract 0320.13
Dropping Partner:
/
Transaction
47 ON-SALEGENERALI ANNUALFEE
Type
Fee Type
Master
P40
Y
Yes
Thjp
0
No
Fee
12/19/08
Total
$847.00
$847.00
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 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 ORANGE
Date: December 19, 2008
Uisder penally of peijury, each person whose signature appears below, certifies and says: (1) 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)
lhtLt
he has read the foregoing and knows the conlents thereof and tisat each of the above statements tlserein made are true; (3) that no person other
/han the applicant or applicants has any direct or indirect interest in the applicant or applicant’s business to be conducted under the liceisse(s) for
vhich this application is made; (4) that the transfer application or proposed transfer is no! made to satisfy the payment of a loan or to fulfill an
1
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
istablish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor; (5)
that the transfer application may
e withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s)
LAURIANODANIELJAMES
f/
Applicant Signature(s)
‘p 211
-
ATTACHMENT 13
Shsneit,irp Ps’p
Department of Alcoholic Beverage Control
State of California
APPLICATION SIGNATURE SHEET
(“SIGN ON”)
Ii. OWNERSHIP TYPE (Check one)
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 laws of the State where signed.
Sole Owner
Li Married Couple
HDomestic Partner
DOther
4, TRANSACTION TYPE
3 LICENSE TYPE
2. INLE NUMBER (Eany)
jPartnership-Ltd
Li Corporation
Lii Limited Liability Company
Partnership
jlPerson to Person Transfer
Original
Li Premise to Premise Transfer
Exchange
,
LiOther
.
I
.
5. APPLiCANT(S) NAME (Last, first middle)
L/JDnI-eL
K
JIv
rues
coca)
6 APPLICANT’S MAILING ADDRESS (Street address/P.O. box, city, state, zip
7. PREMISES ADDRESS (Street address, city zip code)
F//eh’7 CA-
PY
Under penalty of peijury, each person whose signature appears
below, certifies and says: (1) 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 applicants business to be conducted under the
license(s) for which this application is made; (4) that the transfer
ISi
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 pai to $100.
7fl//
SOLEOWNER
DATE SIGNED
SIGNATU$E
8. PRINTED NAME (Last, first, middle)
iueJ
//&2o
Jx
/1
‘
.•
PARTN ERS HIPILIMtED PARTNERSH!P (Signatures of generars only)
x
PARTNER’S PRINTED NAME (Lest, first, rniddle(
‘
I
DATE SIGNED
SIGNATURE
x
PARTNER’S PRINTED NAME (Last, first, middle(
CO RPO RAil 0 N
1 PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
SIGNATURE
DATE SIGNED
Lix
TITLE
jPresident
DATE SIGNED
SIGNATURE
9. PARTNER’S PRINTED NAME (Last, firM, middle)
‘Qo
LLVice President
Li Chairman of the Board
PRINTED NAME (Last, first, middle(
ATE SIGNED
1
D
SIGNATURE
_—
-.----------
TITLE
Li Secretary
JlAsst. Secretary
Li Chief Financia( Officer
LiAsst. Treasurer
LIMITED LIABILITY COMPANY
DYes
11. The limited liability company is member-run
12
ENo
(If no, complete Item #12 below)
D OFFICER (Last, first, middle(
NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATE
13 MEMBER’S PRINTED NAME (Last, first, middle)
MEMBER’S PRINTED NAME (Last, fist, middle(
ABC-2 i-SIC (6/08)
SIGNATURE
DATE SIGNED
ix
SIGNATURE
x
“SIGN ON”
DATE SIGNED