HomeMy WebLinkAboutIntro Only - Lab Tested Digital Cannabis Business Operator Permit Application FormCITY OF SAN LUIS OBISPO
Commercial Business Operators Permit
Application
LAB TESTED SLO LLC
3563 Sueldo Rd. Suite R, San Luis Obispo, Ca, 93401
TABLE OF CONTENTS
I.Commercial Cannabis Application Packet 3-8
A.Owner Consent Form 9-10
B.Owner Release Form 11-12
C.Business Operations Plan 13-14
1.Business Plan 13
2.Cash Handling 13
3.Product Transportation 13
4.Community Relations Plan 14
5.State Licences 14
6.Insurance 14
7.Budget 14
8.Financial Capacity 14
9.Products and Services 15
D.Community Benefit 15
1.Staffing 15
2.Community Support 15
E.Education Plan 15
1.Cannabis Education 15-16
2.Prevention Efforts 16
F.Security Plan (Appendix D)16
1.Security site plan(Appnedix E)16
G.Lighting Plan(Appendix E)16
H.Site and Floor Plan (Appendix E)16
I.Water Efficiency Plan 16
J.Odor Control Plan 16-17
K.Hazardous Materials and Waste Managment 17
1.Hazardous Materials 17
2.Waste Management plan 17
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L.Energy Efficiency Plan 17
II.Appendices 18-37
A.Community Relations Director Contact Form 19
B.Insurance Application 20-29
C.Estimated Income Statement 30
D.Security Plan 31-32
E.Security Site Plan 36-37
E. Camera Locations 36-37
E. Lighting Plan 36
E. Site and Floor plans 33-37
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I. Application Packet
CITY OF SAN LUIS OBISPO
Community Development Department
919 Palm Street, San Luis Obispo, CA 93401
805.781.7170
Commercial Cannabis Business Operators Permit Application
A.Business Information
Business Name: Lab Tested SLO LLC
Property Address: 3563 Sueldo St Suite R, San Luis Obispo CA, 93401
Assessor Parcel Number: 053-253-032 Zoning Designation: C-S
B.Business Type (Check all that apply)
Cultivation - Specialty (Up to 5,000
Sq. Ft. Max)
Cultivation - Small (5,001 - 10,000
Sq. Ft. Max)
Cultivation – Nursery (Up to 10,000
Sq. Ft. Max)
Manufacture (Non-volatile Raw
Product Extraction)
Manufacture (Cannabis Infusion) Manufacture (Itinerant – No
permanent facility)
Manufacturer (Research and
Development)
Distributor Testing Laboratory
Retailer Storefront (Adult-use) Retailer Storefront (Medical) Retailer Storefront (Adult-use and
Medical)
Retailer Non-storefront (Adult-use) Retail Non-Storefront (Medical) Retail Non-storefront (Adult-use and
Medical
Transporter Microbusiness (No more than 50%
GR* from cultivation, distribution
and manufacturing)
Microbusiness (More than 50% GR*
from cultivation, distribution and
manufacturing)
GR – Gross Receipts
C.Definitions
Applicant - The entity petitioning for the Cannabis Business Operator Permit.
Principal(s) - The individual members of the applicant team.
Primary Principal -An individual who has a 10%or greater ownership stake of the applicant business,which
includes partners,officers,directors,and stockholders of every corporation,limited liability company,or general
limited partnership that owns at least 10%of the stock,capital,profits,voting rights,or membership interest of the
commercial cannabis business or that is one of the partners in the commercial cannabis business;the managers of
the commercial cannabis business.
Operator - An applicant that has been licensed and conducts or conducted active cannabis operations.
Majority - A greater number; more than half. An equal number does not constitute a majority.
D.Applicant Information
Name of Primary Responsible Party Completing the Application: Nathaniel Heintz-Hargitt
Title: Manager DOB:
Social Security No:
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If applicant is a not for profit, corporation, partnership or other business entity, please identify:
Name of Business Entity: Lab Tested SLO LLC
Type of Ownership: Partnership LLC
Federal Tax Id: Start Date: 01/23/2019
Mailing Address:
Primary Phone No: Alt. Phone No:
Email Address:
Preferred method of contact (check one) Mail Phone Email
E.Additional Responsible Party Information
Name: Jesus Alonzo Quiroz
Title: Manager DOB:
Social Security No:
Mailing Address:
Primary Phone No: Alt. Phone No:
Email Address:
Preferred method of contact (check one) Mail Phone Email
Please attach additional sheets if there are more than 2 Responsible Parties.
F.Information on Property Owner or Landlord
Name: Matthew W. Anderson
Mailing Address:
Primary Phone No: (Alt. Phone No:
Email Address:
Preferred method of contact (check one) Mail Phone Email
If the applicant is not the legal owner of the property, the application must be accompanied by a notarized Owner’s
Statement of Consent to operate a commercial cannabis business on the property.
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G.Related License Information
The applicant and/or responsible parties has been associated with a commercial cannabis business permit in the
past 10 years.
Yes No (If yes, please provide the following information)
Name:
City or County: Start Date: End Date:
Business Name: Business Type:
Please attach additional sheets if necessary.
Required Submissions (Please check the box for each attachment)
Please attach all applicable documents listed below as part of your application as they pertain to your business type.
For any items that do not apply to your business type, please provide a brief explanation as to why they do not apply.
Business Operations Plan
Business Plan:A plan describing how the commercial cannabis business will operate in accordance with City
code,state law,and other applicable regulations.The business plan must include plans for handling cash and
transporting cannabis and cannabis products to and from the site.
Community Relations Plan:A plan describing who is designated as being responsible for outreach and
communication with the surrounding community,including the neighborhood and businesses,and how the
designee can be contacted.
State Licenses:Copies of the state licenses relating to the commercial cannabis business licenses,the applicant
holds (when available).
Tax Compliance:A current copy of the applicant’s city business operations tax certificate,state sales tax seller’s
permit,and the applicant’s most recent year’s financial statement and tax returns (for first time applicants,the
business operations tax account will be set up in-house after the application has been submitted).
Insurance:The applicant’s certificate of commercial general liability insurance and endorsements and certificates
of all other insurance related to the operation of the cannabis business.
Budget: A copy of the applicant’s most recent annual budget for operations (If available)
Financial Capacity:Financial information such as bank balances,available loans and other sources of funding
the enterprise.
Products and Services: A list/description of the general products and services the business will provide.
Community Benefit:The applicant shall demonstrate to the satisfaction of the City of its intent to local hiring and
community support.
Education Plan:A plan describing the type of cannabis education and prevention efforts that will be provided by
the business to the community.
Security Plan:A detailed security plan outlining the measures that will be taken to ensure the safety of persons
and property on the business site. The security plan must be prepared by a qualified professional.
Lighting Plan:A detailed lighting plan showing existing and proposed exterior and interior lights that will provide
adequate security lighting for the business site.
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Site and Floor Plans:A dimensioned site plan of the business site,including all buildings,structures,driveways,
parking lots,landscape areas and boundaries.Also provide dimensioned floor plans for each level of each building
that makes up the business site,including the entrances,exits,walls and cultivation areas,if applicable.The plans
shall also include the following information about the site:current zoning,parking requirements,consistency with
development standards for the zone,if new development planned for the site,and any other site development
information.
Water Efficiency Plan:The applicant shall demonstrate to the satisfaction of the City that sufficient water supply
exists for the use.
Odor Control Plan:A detailed plan describing how the applicant will prevent all odors generated from the
cultivation,manufacturing and storage of cannabis from escaping from the buildings on the business site,such that
the odor cannot be detected by a reasonable person of normal sensitivity outside the buildings.
Hazardous Materials Plan:To the extent that the applicant intends to use any hazardous materials in its
operations,the applicant shall provide a hazardous materials management plan that complies with all federal,state
and local requirements for management of such substances.
Energy Efficiency Plan:Documentation that the applicant has identified the best way,including carbon free
power sources to provide reliable and efficient energy solutions for their business.
H.City Authorization
I, the applicant, provide authorization and consent for the City Manager or his/her designee to seek verification of
the information contained on this application.
I.Indemnification
I,the applicant,agree to the fullest extent permitted by law,any actions taken by a public officer or employee
under the City of San Luis Obispo regulations for Commercial Cannabis Businesses,shall not become a personal
liability of any public officer or employee of the City.To the maximum extent permitted by law,the permittee shall
defend (with counsel acceptable to the City),indemnify and hold harmless the City of San Luis Obispo,the San Luis
Obispo City Council,and its respective officials,officers,employees,representatives,agents and volunteers from any
liability,damages,actions,claims,demands,litigations,loss (direct or indirect),causes of action,proceedings,or
judgments (including legal costs,attorneys’fees,expert witness or consultant fees,City Attorney or staff time,
expenses or costs)against the City to attach,set aside,void or annul,any cannabis-related approvals and actions
and strictly comply with the conditions under which such permit is granted,in any.The City may elect,in its sole
discretion,to participate in the defense of said action and the permittee shall reimburse the City for its reasonable
legal costs and attorneys’ fees.
J.Nonrefundable Filing Fee
I,the applicant,understand and accept that the nonrefundable filing fee must be submitted with the competed
Commercial Cannabis Business Operators Permit Application and will be retained by the City regardless of the
out-come of the application review.
K.Background – Request for Live Scan Services
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I,the applicant,understand that a completed and processed Request for Live Scan Service,State of California
Form BCIA 8016,as determined by the City of San Luis Obispo,by a duly authorized business must be provided for
the applicant and all interested parties.All applicable fees and charges are the responsibility of the applicants and
interested parties.
L.Disqualification
Application was received late
Application is incomplete or inaccurate
Facility does not meet City business licensing standards
More than one application is received for the same cannabis business type on one property (stacking of
applications)
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