Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout1999.0928.TCSMP.Packet O. 11AIN NOTICE OF SPECIAL SESSION
‘c � `p OF THE
ce. —.4°� FOUNTAIN HILLS TOWN COUNCIL
i
that is A 4
Mayor Morgan
Councilman Apps Councilwoman Wiggishoff
Councilman Wyman Councilman Poma
Vice Mayor Mower Councilwoman Hutcheson
WHEN: TUESDAY, SEPTEMBER 28, 1999
TIME: 2:30 P.M.
WHERE: TOWN HALL CONFERENCE ROOM
16836 E. Palisades, Building C
• CALL TO ORDER—Mayor Morgan
• ROLL CALL
1.) Consideration of the LIQUOR LICENSE APPLICATION submitted by Enrico Cuomo for
Mama's Pizza Cucina located at 16852 East Parkview. The application is for a new Class #12
restaurant liquor license.
2.) ADJOURNMENT.
DATED this 27th day of September, 1999.
By: e4b �N >
Cassie B. Hansen,Town Clerk
The Town of Fountain Hills endeavors to make all public meetings accessible to persons with disabilities. Please call 837-2003
(voice) or 1-800-367-8939 (TDD) 48 hours prior to the meeting to request a reasonable accommodation to participate in this
meeting.
(kw
Interoffice Memo
To: HONORABLE MAYOR AND TOWN COUNCIL
From: CASSIE HANSEN, DIRECTOR OF ADMINISTRATI
Date: September 27, 1999
Re: LIQUOR LICENSE APPLICATION FOR MAMA'S PIZZA CUCINA
Once again, the liquor license application submitted by Enrico Cuomo for Mama's Pizza Cucina is
before you for Council consideration. Due to concerns regarding the site plan for the proposed
remodel/expansion of the restaurant located at 16852 Parkview, this item was removed from the
Council agenda on two occasions. From the date the original application is filed, the applicant has
60 days to complete the submittal or a hearing process will ensue. The deadline for this applicant
is October 5, two days before the next regularly scheduled Council meeting. This is the reason for
a special meeting of the Council.
Community Development and Building Safety staff has worked closely with Mr. Cuomo regarding
the restaurant expansion. It was explained to him that if the total occupancy of the expanded
establishment exceeded fifty patrons, ADA compliance would be required including accessible
.riitTooms and a ramp entrance. Please note on the revised floor plan that half of the area
previously`designated as dining area has been allocated to storage and future expansion. It will be
rovementplans that if the occupancy load exceeds 50, the additional
`41,clearly designated ot�;�th��np p y
,improvements will be required.
Ind ;: �� I ki� w1 with the liquor department agent currently assigned to Fountain Hills.
He gaveu ,copies of the eight factors which are considered by the liquor department in
determining compli •in .ainst a liquor license application. These criteria, found in Title 4, are
attached. Any.combin. an of four or more factors may result in a department protest. As the
e ( i �o the Marshal and me, the department is not interested in the physical layout of
a lis im t: r to insure that 40% of the area is used for the preparation and consumption
of foo issues such as ADA compliance and occupancy load will be dealt with through the
building department. Occupancy compliance will be enforced by the fire marshal.
Based on compliance with Title 4 requirements of a Class 12 liquor license, staff recommends
approval of the application.
If you have any questions on this item, please do not hesitate to contact me.
L
Page 1 of 1 Cassie Hansen Last printed September 27, 1999 11:12 AM
September 27, 1999
kc2),, s.,+,...... -.......c-.22=_L a. ,..,_ _ In,
SECTION 14 Restaurant,or Hotel•Mofei Applicants:
3 Is there a valid restaurant or hotel-motel license at the proposed location? 1 YFS G1 NO if yea,give licensee's name:
tt,0 O ?1'{,�.� �tSever _ _ andlicense#: aio5i -
l.s t Foe. Mid
2. 1f the answer tc Question i is YES you May qualify for an Interim Perxn t to operate while your application is pending consult
A.R.S.Section 4-203.01.and co plete Section 5 of this application
3. All restaurant applicants must complete a Restaurant Operation Plan(Form UC0114)pro by the Department of Liquor.
ofyour annual revenue trust be from food sales? Lrl YES 0 NO
4, Do you understand that 40% �+
SECTION 1; Diagram of Premises:(Blueprints not accepted,diagram must be on this form)
1. Check ALL boxes tit�tapply to your licenser per
[�iJ"/Ezwancts/Exits aquot storm areas
0 Drive-in windows fi Patio enclosures
0 Service windows ' CI Under construction:estimated completion dame.r__........
_
2. Restaurants and Hotel/Motel applicants rntast explicitly depict kitchen equipment and dining facilities.
3. The diagram below is the only area where spirituous liquor is to be sold,served,coostutted,dispensed,possessed,or stored
Clive the square footage or outside dimensions of the licensed premises. OfF tk) t-*1t0 iG
DO NOT IN •►v' L-- ' \.,, ,%1 . . Oki i r-- . .1= . _,----)1
i
Li , 1 1 CovNter-.1 1 1 '
560 o
` PrZtiA
D i rnitk ever)
Egli
�
vTv2c 1411ttli�J fal00 4 off'
�.Pf�rvs,,� �op, rr
I 7 ya�`sQ�c� c
pig STGOE'
in.4 Mf N
, I lj
f TARTM ` + • a - •F 44( CH ��F BOUNDARIES
YOU MUST NOTIFY THE DEP
ENTRANCES, EXITS, OR SERVICE wiNDOWS MADE AFTER SUBMISSION OF THIS DIAGRAM'Orv"--41 19
t0 $
co,
.. T
R1'9-1-240 .Criteria.forissuina,restaurant..license, "1• " I
A. The following factors are to be considered by the Department in determining when a protest will be made
against a restaurant license application. Any combination of four or more factors may result in a
fi, Department protest.
1) The number of cooks, food preparation personnel, waiters or waitresses do not appear to be a
sufficient number to prepare and provide the proposed restaurant services.
t, 2) Restaurant equipment is not of sufficient grade or appropriate to the offered menu.
i3) The proposed menu is not of the type and price likely to achieve 40% food sales.
I 4) There is the presence of a jukebox, live entertainment or dance floor on the premises.
5) There is the presence of a number of bar games and equipment; such as pool tables, dart games, big
screen televisions or arcade type games.
6) Use of a term in the establishment's business name, signage or promotional material which places
emphasis on alcohol consumption. Terms such as bar, tavern, pub, spirits, club, lounge, cabaret,
saloon and other names which denote liquors sales will be considered as indication of non-restaurant
format.
7) More than 60% of the public seating area consists of barstools, cocktail tables and similar type of
seating, indication that such area is used primarily for alcohol consumption.
8) Dinnerware and smallware including dining utensils are not compatible with the offered menu.
(i;imsr
Town of Fountain Hills Memorandum
TO: Cassie Hansen
FROM: Steve Gendler
DATE: August 13, 1999
SUBJECT: Liquor License Application - Mama's Pizza Cucina
The purpose of this memorandum is to provide an endorsement of the attached Liquor
License Application for "Mama's Pizza Cucina" at 16852 Parkview. This facility is designed
primarily for food service with alcohol available incidental to the food.
BACKGROUND INVESTIGATION:
The application is for a new class 12 license.
A Class 12 liquor license, under the specifications of ARS 4-205.02, is for restaurant use
only.
cow To qualify, the statutes require that 40% of the business establishment be devoted to
serving food and that liquor sales be incidental to the food service. A review of the site
plan indicated that well over that percentage is devoted to food preparation and service.
Liquor sales would be incidental to the food service as intended by the class 12 license.
A Class 12 license is exempt from normal restrictions relating to churches, schools and
nearby liquor establishments. A site inspection showed that there is no proliferation of
liquor establishments within the immediate vicinity.
A current business license (#2654), is in place at the facility which is valid through
February 29, 2000.
The applicant, Enrico Cuomo, is an Arizona resident.
A background investigation shows no wants or warrants that would prohibit the applicant
from securing a license.
RECOMMENDATION
Based on compliance with Title 4 relating to the Class 12 liquor license and the fact that
the applicant has a valid business license is in place for the facility, I recommend
approval of this application.
RECEIVED
ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL AUG 1 1 1999
~ ' 400 W Congress#1 ^RaN HILLS
'P0 W Washington 5th Floor -j wN CLERK
hoenix AZ 85007-2934 :-0` Tucson AZ 85701-1352
(602) 542-5141 ,�rn (520) 628-6595
oa}La- la—
APPLICATION FOR LIQUOR LICENSE-roc h ( ci— —ci
q
TYPE OR PRINT WITH BLACK INK — — w # v(p S
ice: Effective Nov.1,1997,All Owners.Agents.Partners.Stockholders.Officers,or Manaeers actively involved in the day to day
rations of the business must attend a Department approved liquor law training course or provide proof of attendance within the last
years. See page 5 of the Liquor Licensing requirements. �..
-"
CTION 1 This application is for a: SECTION 2 Type of ownership: `' 3.7
NTERIM PERMIT Complete Section 5 ❑ W.R.O.S. Complete Section 6 i-- '::
LICENSE Complete Sections 2,3,4,13,14,I5,14 17 INDIVIDUAL Complete Section 6 rJ _ _
'ERSON TRANSFER(Bars&Liquor Stores ONLY) 0 PARTNERSHIP Complete Section 6 ram.
Complete Sections 2,3,4,11,13,15,14 17 0 CORPORATION Complete Section 7 f ll., c'
IOCATION TRANSFER(Bars and Liquor Stores ONLY) 0 LIMITED LIABILITY CO. Complete Section 7
Complete Sections 2,3,4,12,13,15,14 17 0 CLUB Complete Section 8
?ROBATF/WILL ASSIGNMENT/DIVORCE DECREE 0 GOVERNMENT Complete Section 10
Complete Sections 2,3,4,9,13,15,17(fee not required) 0 TRUST Complete Section 6
3OVERNMENT Complete Sections 2,3,4,10,13,15,14 17 0 OTHER Explain
CTION 3 Type of license and fees: LICENSE#: 1 a--
C License: 1"a--- �ED2' c LOWE 2.Total fees attached: $ 13-4•U(2AL -ICATION FEE AND INTERIM PERMIT FEES (IF APPLICABLE)ARE NOT REFUNDABLE.
A service fee of$25.00 will be charged for all dishonored checks(A.R.S.44.6852)
CTION 4 Applicant:(All applicants must complete this section)
'"� �U04-40 €NR�Gc7 £v►si~ppc
�pplicant/Agent's N -
rt one name ONLY to appear on license) Last . First Middle
2orp JPartnership/L.L.C.:
(Fxartly as it appears co Articles of Inc.ar Articles of Org.) i
Business Name: M Prr-lt1S tP I7 -/k ( t3C %►.)A,
(Exactly as it appears on the exterior of premises)
Business Address: Ita $5 c3— f• % vet-R-v--%- EA) tt.0 e �Ovi )T Ai rJ 1.k11.l.S Az. 852i0 8
(Do not use PO Box Number) QV COUNTY ,a, TIP
fit; ) �� Phone:(rV )1 -5-Li-Qv-' Residence '0 SIC-Business Phone:( ,..�/
[s the business located within the incorporated limits of the above city or town? Fit‘ ONO
Mailing Address:
City state Tip
Enter the amount paid for a 06,07,or 09 license: $ . (Price of License ONLY)
DEPARTMENT USE ONLY
Accepted by. Date: g/ 4/ Lic.# a0r7 '7 36 5
Fees: R� T $ 4) gi ~
Application Interim Permit Agent Change Club F.Prints TOTAL
PROCESSING APPLICATIONS TAKES APPROXIMATELY 90 DAYS,AND CIRCUMSTANCES OFTEN RESULT IN A LONGER WAITING PERIOD.
YOU ARE CAUTIONED REGARDING PLANS FORA GRAND OPENING,ETC.,BEFORE FINAL APPROVAL AND ISSUANCE OF THE LICENSE.
0100 I1n998 *Disabled individuals requiring special accommodation,please.callthe Department.
iECTION 5 Interim Permit ,,t to A R.S.4-203.01.
rate business while your .•,
L. iiiiwu intend to operate 'cation is pending you will need an Interim Permit p 2. to the 1� •,�on.
There MUST be a valid license of the same type `u are applying for currently issued
3. Enter the license number currently at the location.
4. Is the license currently m use?❑YES 0 NO• '. •• If n, how long has it been o of use?
•. - ; •• �•'ISSUED AT .I OCA a d N TO THIS APPLICATION.
ATTACH THE LICENSE CURRENTLY LICENSEE of the stated license and
AA. declare thatl am the CURRENT
I.
(Print full name)
location. I have read this application and the contents and . . statements . - true,correct and complete.
•CKNOWLEDGED BEFORE ME
(Signature) this day of Year
Day at'Maoth Month
My commission expires on: (Signanae cf NOTARY PUBLIC)
SECTION 6 Individual or Partnership Owners:
N LISTED MUST SUBMIT A COMPLETED FORM "LIC0101",AN "APPLICANT'TYPE FINGERPRINT CARD,AND $24 FEE FOR EACI-
�H PERSON
RD.
1. Individual: Ci State ,
96 Owned Residence Address
Fast Middle -- — —
Last --_-- /t Z
14'1,1c NI . 103 P-c t°c„ S'crns
up M 0 (vim —' " �o0— — — (s„zs-=S
r _
Partnership Name:(Only the first partner listed will appear on license)
Ci State �, —_----
g��nceAddiess --
Middle -_ %Owned - ---
General-Limited �II
First
❑ ❑
_ - IF NECESSARY)111111111111111111111111111111
(ATTACH ADDITIONAL SHEET
Le:. Is any person,other than the above,going to share in the profits/losses of the business? 0 YESNO
2
•
•
SECTION 7 Corporation/Limited Liability Co.:
(C CH PERSON USTED MUST SUBMIT A COMPLETED FORM "LIC0101", AN "APPUCANT"TYPE FINGERPRINT CARD, AND $24 FEE FOR EACI
0.
❑ CORPORATION Complete questions 1,2,3,5,4 7,8
❑ LLC.
Complete questions 1,2,4,5,4 7and attach copy of Articles of Org. „ , Open Agreement
1. Name of Corporation/LL .•
(Exactly as it appears on Articles of Inc.or Articles of Org.)
2. Date Incorporated/Organized: State where Incorporated/Organized:
3. AZ Corporation Commission File ;.. Date authorized t, do business in AZ:
4. AZ L.L.C.He No: Date auth. '
to do business in AZ:
5. Is Corp./L.L.C.non-profit? 0 YES❑ ,' If yes,give IRS tax exempt number
6._List all directors/officers in Corporation/LL .:
Last First t•.1 e Title Residence Address
_ City State Zip
(ATTA. •.s DITIONAL SHEET IF NECESSARY)
itiest stockholders or controlling members owning 10% er mo -:
Last First Middle Owned Residence Address
City State Zip
•
(ATTACH ADDITIONAL SHEET IF « ARY)
3. If the corporation/L.L.C.is owned b another entity,attach an ownership,and I• - for/officer/members disclosure for the parent
entity. Attach additional sheets as 'ecessary in order to disclose real people.
SECTION 8 Club Applica ts:
EACH PERSON LISTED MUST S MIT A COMPLETED FORM "LIC0101",AN "APPLICA TYPE FINGERPRINT CARD,AND$24 FEE FOR EACH
CARD.
1. Name of Club:
. - Chartered:
(F:actly as it 3 ears an Club Chatter)
(Attach a copy of Club Curter)
?. Is club non-profit? ❑YES ❑NO If yes,give IRS tax exempt number.
List officer and directors:
Last First Middle Title Residence Address � State Me— - _
SECTION 9 Probate,Will Assignment or Divorce Decree of an existing Bar or Liquor Store: •
1. Current Licensee's Name: F
(Exaaly as it appears as license) Last
ast Middle
2. (tiovplee's Name: >s FffStMiddle
License Number. Date of Last Renewal:
3. License Type: OF 4. ATTACH TO THIS APPLICATI►` A CERTIFIED THE WILL PROBA
E DISTRIBUTION
TO THIS INSTRUMENT,
STAPPLICATION.1OR DIVORCE
DECREE THAT SPECIFICALLY ,ISTRIBUTES QUO LICENSE TO
THESECTION 10 Government (for Ities,towns,or counties only)
1. Person to administer this license: First MrddVe
2. Assignee's Name: Lai Fast Muddle
-A SEPARATE LICENSE MUST BE OBT• I r 1 FOR EACH PREMISES FROM Cfi SPIRITUOUS LIOUOR IS SERVED,
SECTION 11 Person to Person Transfer.
Questions to be completed by CURRENT LICENS• E(Bars and Liquor S •res ONLY).
Entity.
1. Current Licensee's Name: t Kiddie (ind►v.,Agent.etc.)
(Exactly as it appears on license) Last
2. Corporation/L.L.C.Name: (p:arily as it appears on license)
3rrent Business Name: (p:grrly as it appears co license)
4. Current Business Address: /
5. License Type:
License Number. Last Renewal Date:
6. Current Mailing Address(other than business)
i
7. Have all creditors,lien holders,interest holders,etc. •,.:• notified of this transfer? al YES 0 NO
8. Does the applicant intend to operate the business w•i e this application is pending? 0 1 0 NO If yes,complete section 5,attach fee,an
current license to this application.
9. I hereby relinquish my rights to the above •:.M'bed license to the applicant named in this application and hereby declare that the statemen
made in this section are true,correct and co,Iillete.
I,
,declare that I am the CURRENT LICENSEE of the stated license. I have read this
(Print full name)
application and the contents and all statements are true,correct and complete.
ACKNOWLEDGED BEFORE ME
X
(Signature of CURRENT LICENSEE) day of
41.1ior this Day of Math Month Year
My commission expires on: (Signature of NOTARY PUBLIC)
4
SECTION 12 Location to Location Transfer.(Bars and Liquor Stores ONLY)
PLICANTS CANNOT OPERATE UNDER A LOCA. ON TRANSFER UNTIL IT IS APPROVED BY THE ' TE.
1. Current Business Name and Address:
(Exactly as it appears on license)
2. New Business Name and Address:
(Do not use PO Box Number)
3. License Type: License N I'- . Last Renewal Date:
4. What date do you plan to move? What date do you plan to open?
SECTION 13 Questions for all in-state applicants:
1. (Dist regarlesn of e to nearest
sance chool: 1 i 000 ft. Name/Address of school: i-0v �.., 01 L� �rt St�oL
)
Qf1't i c al/0 •
2. Distance to nearest church: (/j000 ft. Name/Address of church: fi.4 . ?r,e5&teirtho triv
(regardless of distance)
�� 1300 t r. 4. aLvo.
Pram the: Ca'I PSSEE 0 SUBIFcSFF 0 OWNER 0
PURCHASER(of premises) .
4. If the premises is leased give lessors name and address: L-vv td" 4 J G.(C.0 PtkS to
I. t.4- • ft7, q 52(f 't ' 141- 621A Monthly rental/lease rate$ 14:2-vo
5. What is the total business indebtedness of the applicant for this license/1 'on? $ 0
Does any one creditor represent more than 10%of that sum? 0 YES NO If yes,list below. Total must equal'100%.
Last First Mddle %Owed Resideoee Address
- -- - City State ziE
(ATTACH ADDITIONAL SHEET IF NECESSARY) ' _ _ _ _i
6. What type of business will this license be used for?(BE SPECIFIC) P 122 A 4 P PST A- S Thsol-v p ..rr.
7. Has a license,,Gr a transfer license for the premises on this application been denied by the state within the past one(1)year?
0 YES UNO If yes,attach explanation.
8. Does any spirituous liquor manufacturer,wholesaler,or employee have/any interest in your business? OYES (31
9. Is the premises currently licensed with a liquor license? 0 YES L!NO If yes,give license number and licensee's name:
(Exactly as it appears on license)
SECTION 14 Restaurant,or Hotel-Motel Applicants: , .
hotel-motel license at theproposed location? E YES 0 NO If yes,give licensee's name:
1. Is there a valid restaurant or {y
/1 VOI4V �i.�►�� ��5e'PP and license ail I
ter First Wide
2. If the answer to Question 1 is YES,you may qualify for an Interim Permit to operate while your application is pending,consult
A.R.S.Section 4-203.01;and complete Section 5 of this application.
3. All restaurant applicants must complete a Restaurant Operation Plan(Form LIC0114)provi by the Department of Liquor.
4. Do you understand that 40% of your annual gross revenue must be from food sales? YES 0 NO
SECTION 15 Diagram of Premises:(Blueprints not accepted,diagram must be on this form)
1. Check ALL boxes t apply to your licensed prase s:
Ld'Entrances/Exits Q yquor storage areas
0 Drive-in windows a Patio enclosures
0 Service windows ' 0 Under construction:estimated completion date
2. Restaurants and Hotel/Motel applicants must explicitly depict kitchen equipment and dining facilities.
3. The diagram below is the only area where spirituous liquor is to be sold,served,consumed,dispensed,possessed,or stored.
Give the square footage or outside dimensions of the licensed premises. /Mrt,tN �-Nt4 ix
DO NOT 1N �� ��® /RAflntGR'p 12 14(
Vo ID U
IPAI 5.
4
.E 1 &-)kir etz,l Ep.
r.g'
dupwl/ 1 Q12vA 4
MEM
0 0 , ,',, rim 1
Ott l'ttePr i /?fee 4 Ilan )e
/ 5'foP e
uvul)) Mt
YOU MUST NOTIFY THE DE
PARTMENT OF (O1JO R OF ANY CHVIGES OF BOUNDARIE
ENTRANCES, EXITS, OR SERVICE WINDOWS MADE AFTER SUBMISSION OF THIS DIAGRAM.
6
SECTION 16 Geographical Data: A SAMPLE FOR THIS SECTION IS PROVIDED ON THE BACK OF THIS
PAGE.
(IPt below the exact names of all churches,schools,and spirituous liquor outlets within a one half mile radius of your proposed location.
1. PLICf T *
2. 13A l�5 f FI. f h b+t SCltvt)t,
3. S6 Ul � Pup, NT
•. a li,Z B�V �
4. F i. P9€5��r1t:�t,� yet}
5. f 1,I .. t�1 to tk 'S6•4 Cv L L
l
6. A3
0
HOnr7p4N,A
8.
9.
10. k
11. V
12.
13.
1.
1
(ATTACH ADDMONAL SHEET IF NECESSARY)
A=Your business name and identify cross streets.
SECTION 17 Signature Block:
1
I, -tia-i
014 0 declare that 1)I am the APPLICANT(Agent/Club Member/Partner),making this
(Print name of APPLICANT/AGENT listed in Sermon 4 Question 1)
application;2)I have read the application and the contents and all statements are true,correct and complete;3)that this application is not being
made to defraud or injure any creditor,taxing authority,regulatory authority,or
as indicated, has an interest in thecense transferor,4)that no other person,firm,or corporation,except
membe . . ,directo.. . stoc..spirituous
listed have been convicted of theseor which felony in the past fiments are ve and 5) that none of the owners,partners,
(5)years.
_� OFFICIAL SEAL'dil ._
(� == SHUYUAN A. U ClCvovt'LIDGID BEFORE ME
(Si_Ik
Ft"
My Comm.EwireI Mooch Year
vly mission expires on: M p
com
(Signature of NOTARY PUBLIC)
SAMPLE
• GEOGRAPHICAL DATA
and
he area adjacent to the map provided below and indicates
alcoho youric proposed
dage ulocation
i the exact names radius all
ofchurches,
your proposed location.
within a 1/2
(See example below)
A = A licant
Series 12
01 Pink Ele hants es 06
Seri -
02 Mama' s Rest .
Series 12
03 Corner Li ors
Series 09
04 Joe' s Groceries
Series 10
05 Lions Club
Series 14
06 Bur ers R Us
Series 07 N
07 Pizza Perfect
Series 07
1/ Mi.
08 Bill Bobs Bar Series 06
C; St . Anth°1---- 11 --irch
Latrobe 1111
1
10 St . Anthonys School NI
1Burbank Middle Schoo1/2Mi. Lockwood 3i Mi.
12 First United Baptist Church
13 •
8
9 10
14
15
A.R.S . Section 4-207 .A reads as follows:
1/2 Mi.
remises which are. at the tir
A. No retailers license shall be issued
for
Diny recptor, within three hundred(300;
the license application is received by the
l
horiz
ontal feet of a church, within three hundred(300)
horizonta or feet
a of
public or private school building iortwithinethree hundred(300) horizonta
rgy
grades one (1) through twelve (12) .
feet
of a fenced recreational area adjacent to such school building.
Lir
• ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL
11/�
800 W Washington 5th Floor 400 W Congress#150
low Phoenix AZ 85007-2934 T.� Tucson AZ 85701-1352
(602) 542-5141 �'ar �'' (520) 628-6595
z✓ . . ax:� ;. �' �s s^
;w• "i' .:ek't":o o. �+ �a ''�i'`� S'� :�i @ „ 'C,y, c"43 \ a y f M 2
eil
LICENSE# I
1. List by Make,Model and apacity of your:
Grill Pitnitt w..J ("0..--Let %de"t-US (9{24.4.4, Cb ��{,t f1►C. '-t lrl cVL..
Oven fPt,
•6l v 0l P%Lz>°► C�vew�5
Freezer 6) o cvve- i 6
Refrigerator U -P 0Ot2 - rir 41 L t 8tLX
Sink J �rtoft¢ Strw.. V-^ 1.`
Dish Washing Dwoo
Facilities ,
Food Preparation 4" S Dwt -1 rb4.tr V 1-1-" 9 2 TYttit.Stir
Counter(Dimensions)
Other ,Y Pr/Go Clu{e¢
2. Print the name of your restaurant I'1 t`mAs Pt zza- 0,0 c >.JA-
3. Attach a copy of your menu(Breakfast,Lunch and Dinner including prices).
4. List the seating capacity for.
a. Restaurant area of your premises [ SO
b. Bar area of your premises [ +
c. Total area of your premises [ 54'
5. What typpe dinnerware and utensils are utilized within your restaurant?
Reusable 0 Disposable
6. Does your restaurant have a bar area that is distinct and separatteom the taurant seating? (If yes,what
percentage of the public floor space does this area cover). rE Yes l % 0 No
cy What percentage of your public premises is used primarily for restaurant dining?
(Does not include kitchen,bar,cocktail tables or game area.)
*Disabled individuals requiring special accommodations,please call the Department
L.ic0114 11N7
8. Does your restaurant Contain any games or television? 0 Yes E sio
(If yes,what types and how many?Pool tables,Video Games,Darts, etc.)
L
9. Do you have live entertainment or dancing? 0 Yes 0'No
(If yes,what type and how often?)
. 10. Use space below or attach a list of employee positions and their duties to fully staff your business.
© PizZor
�► P Pc i - cad
A g —
0 C.c7vtv-LtL- ' D.J
� t--,, ty__—
et./IZ t C o a O tL 0 , being fast duly sworn upon oath,hereby depose,swear and declare,
(Print full name)
under penal of perj ,that I am e applicant named hereof and that the application has been read by me and that the contents herein
and to is co tamed herein true,convect and complete.
X SUBS')IN MY PRESENCE AND SWORN TO before me
(Signature of APPLICANT) /Q4
.
this day of /v ^� , l ( (
Day cf Meath uMmth Year
My commission expires on:: �4 �o k
( rgnature of NOTARY PUBLI
OFFICIAL SEAL-
. SHUYUAN A.SUAREZ
? e� Notary Pudic-Stara of NRI EZ
MARICOPA COUNTY
s 9 NIyot ini,youmar,R.,g
2
• 12. Payroll Records ,
A. Copies of all reports required by the State and Federal Government
B. Employee Log(A.R.S.4-119)
C. Employee time cards(actual document used to sign in and out each work day)
D. Payroll records for all employees showing hours worked each week and hourly wages
The sophistication of record keeping varies from establishment to establishment. Regardless of
each licensee's accounting methods,the amount of gross revenue derived from the sale of food and
liquor must be substantially documented.
REVOCATION OF YOUR LIQUOR LICENSE MAY OCCUR IF YOU FAIL TO COMPLY
WITH A.R.S.210.A.7.AND A.R.S.205.02.G.
A.R.S.210.A.7. The licensee fails to keep for two years and make available to the department upon
reasonable request all invoices, records, bills or other papers and documents relating to the purchase,
sale and delivery of spirituous liquors and,in the case of a restaurant or hotel-motel licensee, all
invoices,records, bills or other papers and documents relating to the purchase,sale and delivery of
food.
A.R.S.205.02.G. For the purpose of this section: •
•
1. "Restaurant" means an establishment which derives at least forty percent (40% 'of its
gross revenue from the sale of food. .rt ';
2. "Gross revenue" means the revenue derived from all sales of food and spirituous liquor on3
the licensed premises,regardless of whether the sales of spirituous liquor are made-under:
a restaurant license issued pursuant to this section or under any other license that has c
been issued for the premises pursuant to this article. ..
I,(print Licensee/Agent's Name): `y
Last First Middle
have read and fully uncle aspects of this statement.
ACKNOWLEDGED BEFORE ME
X this L# day of , r"q ,
OFFICIAL gn icensee/Agent) Day of Month Month Year
«.�.:�.. SHUYUAN A.SUAREZ
1. Notary Public-State of Arizona
Pa MARtCOPA COUNTY
My Comm,IOW MM,g,f001 "144A .Zct <U�t.c_L ,t,,,`
on:
Day of Month Month Year (Signature of NOTARY LIC)
Lir
MAKE A COPY OF THIS DOCUMENT AND KEEP IT WITH YOUR DLLC RECORDS
ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL
'rl:fi{yj�
�`�' 400 W Congress#150
800 W Washington 5th Floor _° �� � gr
�''• Tucson AZ 85701-1352
Phoenix AZ 85007-2934 z T,�
(602) 542-5141 -,rno, (520) 628-6595
HOTEL-MOTEL AND RESTAURANT LICENSES
RECORDS REQUIRED FOR AUDIT OF SERIES#11  LICENSES
MAKE A COPY OF THIS DOCUMENT AND KEEP IT WITH YOUR DLLC RECORDS
In the event of an audit,you will be asked to provide to the department any documents necessary
to determine compliance with A.R.S. 205.02.G. Such documents requested may include however,
are not limited to:
1. All invoices and receipts for the purchase of food and spirituous liquor for the licensed
premises. If you do not have all food or liquor invoices, please contact your vendors
immediately and request copies of missing invoices. These must be available for pick-up at
the time of the Audit Interview Appointment. If all food invoices are not available at that
time,you may not be given credit for all food sales.
2. A list of all food and liquor vendors
3. The restaurant menu used during the audit period
• 4. A price list for alcoholic beverages during the audit period
5. Mark-up figures on food and alcoholic products during the audit period
Cry 6. A recent,accurate inventory of food and liquor(taken within two weeks of the Audit
Interview Appointment)
7. Monthly Inventory Figures -beginning and ending figures for food and liquor
8. Chart of accounts (copy)
9. Financial Statements-Income Statements-Balance Sheets
10. General Ledger
A. Sales Journals/Monthly Sales Schedules
1) Daily sales Reports (to include the name of each waitress/waiter, bartender, etc. with
sales for that day)
2) Daily Cash Register Tapes -Journal Tapes and Z-tapes
3) Guest Checks
4) Coupons/Specials
5) Any other evidence to support income from food and liquor sales
B. Cash Receipts/Disbursement Journals
1) Daily Bank Deposit Slips
2) Bank Statements and canceled checks
11. Tax Records
A. Transaction Privilege Sales, Use and Severance Tax Return(copies)
B. Income Tax Return-city, state and federal(copies)
C. Any supporting books, records, schedules or documents used in preparation of tax
returns
LIC1013 11/1998
ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL
1I.1✓
..A.411111\' 400 W Congress#150
800 W Washington 5th Floor
:
Phoenix AZ 85007-2934 r '=' ' Tucson AZ 85701-1352
(602) 542-5141 \``1SJJ�`.e,�Itl►go gr(520) 628-6595
QU
ESTIONNAIRE
READ CAREFULLY, INSTRUMENT IS A SWORN DOCUMENT
An extensive investigation of your background will be conducted. False or incomplete answers could result
in criminal prosecution and the denial or subsequent revocation of a license or permit.
TO BE COMPLETED BY EACH OWNER. AGENT PARTNER. STOCKHOLDER (10% OR MORE), MEMBER, OFFICER OR MANAGER. ALSO EACH PERSON
COMPLETING THIS FORM MUST SUBMIT AN"APPLICANT"TYPE FINGERPRINT CARD WHICH MAY BE OBTAINED AT THE DEPT. FINGERPRINTING MUST BE
DONE BY A BONA FIDE LAW ENFORCEMENT AGENCY.THE DEPARTMENT DOES NOT PROVIDE THIS SERVICE
There is a$24.00 processing fee for each fingerprint card submitted.
A service fee of$25.00 will be charged for all dishonored checks(AILS.44.6852)
TYPE OR PRINT WITH BLACK INK
1. Check appropriate [Owner,Agent,Partner,Stockholder,Member or Officer ElManager(Only)
box (Complete Questions 1-16&20) (Complete All p Questions except#10,l0a&21)
Licensee or Agent must complete#21 for Manager Licensee or Agent must complete#21
la. Name: e,optio E NR-t c,v '"'v 15�p o Date of Birth: I 0(3o)c 9
Last First Middle
2. Name of Licensed Premises: 11 Ifi-1 A S Pi 7-7-A• l�\U i,A- Premises Phone:( q) ) 0 34- 5- v
3. Licensed Premises Address: I(v$5 .-- E . PA_iLV i G,J frcvE F.µ. 15 524,$ Liquor License# i' -
Street Address (Dona use PO Boor#) City County Tip (If this Tocaticn is currently licensed)
4. Drivers License#: 60 r'L_ State A- Residence Phone:(W 0) 5-1 5- `-'143 s 7,-
titiwight: 5-i D Weight i 0 ' Eyes: )t - .-- Hair: a g-w)' Place of Birth: Nev-) `f D f--V-_ y
.. S�'
City
5. Name of Spouse: C v 0 K D Loa-a AN J iv I e O ev M OTT Date of Birth (0- -101
Last First Middle Maiden t.1:
6. You area bona fide resident of what state? f c a-t Z-w A- If Arizona,date of residency. (0- I- (` ..
7. If you have been a resident less than three(3)months,submit a copy of driver's license or voter registration card.
8. Indicate your employment or type of business during the past five(5)years,if unemployed part of the time,so state. List most recent 1st.
FROM TO DESCRIBE POSITION EMPLOYER'S NAME OR NAM OF BUSINESS
Month/Year Month/Year OR BUSINESS (Give street address,city,state&zip)
nil i lqi CURRENT II () Pr2zA-tvc 4A- -t,ot 4/ rJ • fit t?� 9-D. l 03
ow � n 5Go- ' al-ye- A-Z Ss/
S
iv l 4 6, 11 u I co C err l e-t'.i l y- 9i-z.--)41- t a to 0 IQ- 5 C.o-r-i s o-4-t-' e,p.
Y.A'turt o0 . et,.(1 . Sc-CA—tcj 1A-t.e— A-7.
t. /1( 1'1 3 I 0/i /9 & UhAF>t-wi 0- ?17�A. t.. A-. Gel-L.r-o fa-AA► -
&•it • Go?P . 0 c�C.
•
(ATTACH ADDITIONAL SHEET IF NECESSARY) t
9. Indicate your residence address for the last five(5)years:
FROM TO RESIDENCE
Month/Year Month/Year i,�, Street Address City State ET
I‘ I i 5 1�; CURRENT
t (�� i Q D i.i�'C.$
`r swz-yfl4-c A-z. iS zs`) '5c zi3- A2 'asZsg
ji II1611 1%-la- IJ•ei3/t.)A1 It it tom
� Ai�a� -Veil quo E. ;�S 3Ei l t
uC 0101 01/1999 Disabled individuals requiring special accommodations please call(602)542-9051
10. As an Owner,Agent,Partner,Stockholder,Member or Officer,will you be physically present and operating el YES ONO
the licensed premises? If you answered YES,how many hrs/day? ,answer#10a below. If NO,skip to#11.
l0a.Have you attended a Department approved liquor Law Training Course within the last 5 years? (Must provide proof) ❑YES O
If the answer to#l0a is"NO",course must be completed before issuance of a new license or approval on an existing license.
11. Have you EVER been detained cited arrested indicted or summoned into court for violation of ANY law or 0 YES 1;NO
dordinance(regardless of the disposition even if dismissed or expunged)? For traffic violations.include only
ose that were alcohol and/or drug related
12. Have you EVER been convicted fined frosted bond been ordered to deposit bad imprisoned had sentence 0 YES Ei'NO
suspended.placed on probation or parole for violation of ANY law or ordinance(regardless of the disposition
even if dismissed or expunged)? For traffic violations,include only those that were alcohol and/or drug related
13. Are there ANY administrative law citations,compliance actions or consents,criminal arrests,indictments or 0 YES B<0
summonses PENDING against you or ANY entity in which you are now involved? // -
14. Have you or any entity in which you have held ownership,been an officer,member,director or manager EVER 0 YES l3NO
had a business,professional or liquor APPLICATTON OR LICENSE rejected denied revoked suspended or
fined in this or any other state?
15. Has anyone EVER filed suit or obtained a judgment against you in a civil action,the subject of which 0 YES E7N0
. involved fraud or misrepresentation of a business,professional or liquor license?
16. Are you NOW or have you EVER held ownership,been an officer,member,director or manager on any other 0 YES El l<10
liquor license in this or any other state?
If any answer to Questions 11 through 16 is "YES"YOU MUST attach a signed statement giving complete details.
If you checked the Manager box on the front of this form,fill in#17-19 and 20,all others skip the following box(17-19)and go to#20
Manager Section
17. Have you attended a Department approved Liquor Law Training Course within the last 5 years? (Must provide proof) 0 YES EKIO
If the answer to#17 is"NO"course must be completed BEFORE ISSUANCE of a new license OR APPROVAL on an existing license.
rimw Do you make payments to the licensee? 0 YES 0 NO If"yes",how much?$ per month. Total debt to licensee$
19. Is there a formal written contract or agreement between you and the licensee relating to the operation or management of this business?
0 YES 0 NO If"yes",attach a copy of such agreement
20. I, Cil✓4-4 W CV cm v ,hereby declare that I am the APPLICANT filing this questionnaire.
(Printfull. •v. 'cant)
I have re 's stionn•',• and the c''tents and all statements are t•rue,correct and complete.
X _ _�' .'oF�ic A R SEAL
•CKNOWLEDGED BEFORE ME
.11 - Notary PUt -Sta DIIltlzoda Of �r.,,„,
trl
MARICOPAC� -., y .
- • Mmih Mash Year�";'% My COMM.iatal►�Ned
My commission expires on: 1114 nth - " ' 6 f -AA.. . 1
Day of Mmth Maids Year Signature of NOTARY PUBLIC)
FILL IN THIS SECTION ONLY IF YOU ARE A LICENSEE OR AGENT APPROVING A MANAGER APPLICATION
Licensee or Agent Approval of Manager
21. I,(Print Licensee/Agent's Name):
Last Kiddie First
Hereby authorize the applicant to act as manager for the named liquor license.
ACKNOWLEDGED BEFORE ME
this day of ,
co' (Signat re ofLICENSEE/AGENT) Dayat'Wad i Moon Year
My commission expires on:
Day of Month Month Year (Signature of NOTARY PUBLIC)