HomeMy WebLinkAboutRFI23-0500 Approved ABC 221 FormDepartment of Alcoholic Beverage ControlStaleofCalifornia
DAILY LICENSE APPLICATION ABC USE ONLY
Receipt #FeeLicense#
Complete all applicable items.Submit this application to your local ABC District Office with
the required fee payable to ABC.To determine fee(s)due,visit hi;|-)s://wwvv,ab ..i.no'.-
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ABC District Office is available at
iil’ps y.'www.ar.■r 'v ahr.-22l-nslr.’iv
Diagram Requested
□Yes □No
Conditions Requested
□Yes □NoOncethedailylicenseisissued,fees cannot be refunded.Listing of
-vv.-.v.nl'C.ca.qov'cr.[nnf~:.Please visit License Type
□B &Wforfurtherinstructions.□General 3 SpecialSECTION1.ORGANIZATION AND LICENSE TYPE INFORMATION
Organization Name Tax ID
23-7074359COHASSETCOMMUNITYASSOCIATION
Organization Mailing Address
11f MAPLE CREEK RANCH ROAD,COHASSET.CA 95973
LICENSE TYPE
S^pecial Daily Beer and Wine
3 Amateur Sports Organization
j Charitable
.j Civic
3 Cultural
3 Fraternal
3 Political
3 Religious
3 Social
3 OtheriART SHOW
□Daily General
3 Political Party/Affiliate SupportingCandidateforPublicOfficeorBallot
Measure
3 Organization Formed for Specific
Charitable or Civic Purpose
3 Fraternal Organization in Existence over
Five Years with Regular Membership
□Religious Organization
□Vessel per Section 24045.10 B&P
(S50.00)
□Special Temporary License
□Television Station per Section 24045.2
or 24045.9 B&P
□Non-profit Corporation per Section
24045.4 and 24045.6 B&P
□Person conducting Estate Wine Sale
per Section 24045.8 B&P
□Women’s Educational and Charitable
Organization per Section 24045.3 B&P
□Other Special Temporary License
Per Section;
License #:Amount:
SECTION 2.EVENT DETAILS
Event Dates Total #of Days Hours of Alcoholic Beverage Sales,Service and/or consumption Virtual Event Mark Yes,if thereventis100%0 No virtual11/04/2023 1 5:00 p.m.To 8:00 p.m.□Yes
Event Address (Street #,name,and city)
11 MAPLE CREEK RANCH ROAD cohasset community association
Event Location Description (Jones Park,Pavilion A,etc.)Location Within the City Limit
□Yes 0 No
Event Type3Barbeque DDinner
3Birthday
□Concert
□Carnival
□Dance
Type of Entertainment
Music,Vendors,Food
Event Open to Public
□Sporting Event
□Social Gathering
□Wedding
EOther;ART SHOW
□Yes □No□Festival
□Lunch
□Mixer
□Picnic
Estimated Attendance Security Guard If Yes,how many
□Yes 0No
Outdoor Event
80 □Yes**If Yes.a diagram of the
E No event area is required
REQUIRED
□By checking this box,you are certifying that you understand the requirements detailed in Business and Professions (B&P)Code Section
25682(c)which state that a nonprofit organization that has obtained a temporary daily license from the department must designate a person(s)toreceiveRBStrainingcertificationpriortotheevent,and that designated person(s)shall remain onsite for the duration of the event.
SECTION 3.CONTACT INFORMATION
Contact Person Phone Number Email Address
DAN HOLMES,PRESIDENT (530)514-1125 DAN.HOLMES530(®GMAILCOM
SECTION 4.SIGNATURES AND APPROVALS
I attest that I am authorized by the organization named above to make this application on its behalf.
Organization's Authorized Representative Name Phone Number Si^ature Date Signed10/02/2023DANHOLMES,PRESIDENT (530)514-1125 f'
Property Owner Approval By (Name)Required Phone Number Signature .Date Signed
^0/02/2023
Date Signed
KATHLEEN HOLMES,TREASURER (530)591-9595
Law Enforcement Approval By (Name),if applicable Phone Number Signature
District Office Approval By (Name)Phone Number ABC Employee Signature Issuance Date
The above named organization is hereby licensed,pursuant to the California B&P Code Division 9 and California Code of Regulations,to engageinthetemporarysaleofalcoholicbeveragesforconsumptionattheabovenamedlocationfortheperiodauthorizedabove.B&P Code Section25682(c)requires that a designated RBS-trained person(s)shall remain on site for the duration of the event.Failure to comply with this requirementwillresultinimmediatecancellationofthepermit.This license may be revoked summarily by the Department if,in the opinion of theDepartmentand/or the local law enforcement agency,it is necessary to protect the safety,welfare,health,peace and morals of thepeopleoftheState.
ABC-221 (Rev.09/23)
KORY L.HONEA
SHERIFF -CORONER
crcfiyArr'Y^
Daily ABC License Approval Sheet
The Butte County Sheriff's Office has done a preliminary review of the event listed below,and
determined that there are no objections from the Sheriff's Office standpoint.
The next step in the process is obtaining approval from the Butte County Department Services Planning
Division.Please provide this cover letter with your application to the Planning Department for review
and approval.Upon approval,return this cover letter with your application packet to the Sheriff's Office
for final approval and issuance of your license.
Organization Contact Information fphone #or email):C W ^^0n/^l ^
Cr^^K
Ct\
Organization Name:
Date of Event:
uAPN/Address:
NOTES:
Department Services Planning Division
Denied;Approved:
(Date)(DoteJ (Signature)(Signature)
Butte County Sheriff's Office
Denied:Approved:
(Dote)(Signature)(Date)(Signature)