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State of California
Gavin Newsom, Governor
Department of Alcoholic Beverage Control
LICENSED PREMISES DIAGRAM (RETAIL)
1. APPLICANT NAME (If Individual: Last, first, middle) 2. LICENSE TYPE
3. PREMISES ADDRESS (Street number and name, city, zip code) 4. NEAREST CROSS STREET
The diagram below is a true and correct description of the entrances, exits, interior walls and exterior boundaries of
the premises to be licensed, including dimensions and identification of each room (i.e., "storeroom", "office", etc.).
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It is hereby declared that the above-described premises and character of premises, as indicated on the reverse side,
will not be changed in accordance with Rule 64.2 of the California Code of Regulations without first notifying and
securing approval of the Department of Alcoholic Beverage Control. Substantial changes to the premises may
require an application fee in accordance with Section 24072 of the Business and Professions Code. I declare under
penalty of perjury that the foregoing is true and correct.
APPLICANT SIGNATURE (Only one signature required) DATE SIGNED
FOR ABC USE ONLY
CERTIFIED CORRECT (Signature) PRINTED NAME INSPECTION DATE
ABC-257 (07/19)
Department of Alcoholic Beverage Control
PLANNED OPERATION (RETAIL)
SECTION I - FOR ALL RETAIL APPLICANTS
1. APPLICANT NAME(S) (If Individual: Last, First, Middle Initial)
3. PREMISES ADDRESS (Street number and name, city, zip code)
2. LICENSE TYPE(S)
4. NEAREST CROSS STREET
5. TYPE OF BUSINESS (Choose one that best describes the planned operation)
Full Service Restaurant Cafeteria/Hofbrau Cocktail Lounge Private Club
Deli or Specialty Restaurant Comedy Club
Night Club
Veterans Club
Cafe/Coffee Shop
Brew Pub
Tavern Fraternal Club
Bed & Breakfast Theater Wine Tasting Room
Supermarket Membership Store Service Station Swap Meet/Flea Market
Liquor Store Department Store Convenience Market Drive-in Dairy
Variety/Drug Store Gift Shop/Florist Convenience Market w/Gasoline
Other - describe:
6. PATRON CAPACITY 7. SURROUNDING AREA 8. PREMISES IS LOCATED IN
Commercial Rural Free Standing Building
Residential Industrial Shopping Center (Name):
Other 10 Units or Less More than 10 Units
9. FOOD SERVICE 10. PARKING LOT? 11. PATIO? 12. WILL YOU HIRE A
MANAGER? (Rule 57.5)
13. WILL YOU HAVE A
FOOD LESSEE? (Rule 57.7)
None Minimal Full Meals Yes No Yes No Yes No Yes No
14. MEAL TYPE 15. TYPE OF FOOD 16. HOURS OF FOOD SERVICE
BREAKFAST HOURS
Dinner House
Seafood American Greek Indian French From: To:
LUNCH HOURS
Fast Food/Deli Other: Chinese Korean Italian Thai From: To:
DINNER HOURS
Pizza/Pasta Japanese Other: From: To:
17. OPERATING HOURS
Opening Time
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Closing Time
18. ENTERTAINMENT (One or more may apply. Please describe any entertainment with an asterick (*) below)
None *Amplified Music Patron Dancing Card Room
Recorded Music *Live Entertainment Bikini/Topless/Exotic Movies
Juke Box *Floor/Stage Shows
Pool/Billiard Tables
"Hot Spot"/Lottery
*Other
Karaoke
*Amateur/Pro Sports Events
Video/Coin-Operated Games
*Description:
19. PREMISES IS LOCATED ON 20. TYPE OF STRUCTURE
Major Thoroughfare Secondary Street Single Story Two-Story
Other Multi-Story - Number of stories:
21. PASS-THROUGH WINDOW? 22. FIXED BARS? 23. WHAT PERCENTAGE OF YOUR TOTAL SALES WILL BE
ALCOHOLIC BEVERAGES?
Yes No Yes - how many: No
FOR ABC USE ONLY
24. INFORMATION GIVEN (R-27, R-107, Sec. 25612.5, Sec. 23790.5, etc.) 25. DATE ENTERED INTO CABIN
ABC-257 (REVERSE) (07/19)
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Completed 5 February 2021

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