HomeMy WebLinkAbout20 - CC-8 - Attachment 3 - 4/15/2014Department of Alcoholic Beverage Control
DAILY LICENSE APPLICATIONIAUTHORIZATION - Non Transferable
lnstrucrions: Con rlete all Wpm Subunit to local ABC Distrid Office with required fee (Cashier's ChecA or
Money Order) payable to ABC. Once license is issuers fee cannot be refunded For a listing of ABC District
Offices ptease visit hup:&4— a&ca gov/distmap.himf
Pursuant to the authority granted by the organization named below, the undersigned hereby applies for the
licenses) described below.
State of California
Edmund G. Brown Jr.. Governor
LICENSE NUMBER GED CODE
RECEIPT NUMBER
FEE
S ORGANIZATION'S NAME CONDITIONS REQUIRED DIAGRAM REL}U1RE11
]Yes ENO [ `Yes ] No
2. LICENSE TYPE (Check appropriate license type AND organization type}
a. ❑ Daily General ($25.00) (includes beer, wine and distilled spirits)
Political Party/Affiliate Supporting Candidate for [] Fraternal Organization in Existence Over Five Years
Public Office or Ballot Measure with Regular Membership
Organization Formed for Specific Charitable or Civic Purpose [—]Religious Organization
Other: ]Vessel per Section 24045.10 B&P ($50.00)
NUMBER OF DISPENSING POINTS
D. Special Daily Beer ($25.00) Special Daily Beer & Wine ($50.00) []Special Daily Wine ($25.00)
F' Charitable Fratemal f -I Social Political Other:
L, Civic Religious F Cultural Amateur Sports Organization NUMBER OF DISPENSING POINTS
c FISpecial Temporary License ($100.00) (Different privileges depending on statute)
]Television Station per Section 24045.2 or 24045.9 B&P F] Person conducting Estate Wine Sale per Section 24045.8 B&P
Nonprofit Corporation per Sections 24045.4 and 24045.6 B&P ] Women's Educational and Charitable Organization per
Section 240+45.3 B&P
] Other Special Temporary Licenses, per Section
License number Amount $
3. EVENT TYPE — —
[� Dinner ❑ Dance [] Wedding []Lunch [:]Picnic Barbeque ]Social Gathering
[] Sports Event [] Concert [] Birthday D Mixer [:]Carnival [] Dinner Dance [] Other:
4. TOTAL # OF DAYS 15 ESTIMATED ATTENDANCE
7. EVENT DATE(S)
9. EVENT LOCATION (Give FoUldy name, d any, street number and name,
[]Yes L]No
13. AUTHORIZED REPRESENTATIVE'S NAME
HOURS OF ALCOHOLIC BEVERAGE SALES, SERVICE AND/OR CONSUMPTION
From_ To
8. EVENT IS OPEN TO THE PUBLIC
]Yes ❑ No
[] Festival
12. SECURITY GUARDS
]Yes No If yes, how many?
14. REPRESENTATiVE'S TELEPHONE NUMBER
15. REPRESENTATIVE'SADDRESS
16. ORGANIZATIONS MAILING ADDRESS (K ddfe n1 rroal 015 above)
17. AUTHORIZED REPRESENTATNft'SIIGNATURE - - 18, DATE SIGNED
PROPERTY OWNER APPROVAL BY 1Name), REQUIRED PHONE NUMBER PROPERTY OWNER SIGNATURE DATE SIGNED
LAW ENFORCEMENT APPROVAL BY 1Name), IF APPLICABLE PHONE NUMBER LAW ENFORCEMENT SIGNATURE DATE SIGNED
01 STRI C T OFRCE APPROVAL BY INamel A BG EMPLOYE E SIGN ATU RE ISSUANCE DATE
The above-named organization is hereby licensed, pursuant to the California Business and Professions Code Division 9 and California Cade of Regulations,
to engage in the temporary sale of alcoholic beverages for consumption at the above named location for the period authorized above. This license does not
include off -sale fto-go") privileges.
This license may be revoked summarily by the Department if, in the opinion of the Department and/or the local taw enforcement agency, it is
necessary to protect the safety, welfare, health, peace and morals of the people of the State.
ABC -221 (rev. 01-11)