HomeMy WebLinkAboutIntro Only - Coastal Retail SLO, LLC Permit ApplicationCITY 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:
Property Address:
Assessor Parcel Number: Zoning Designation:
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 compa ny, 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:
Title: DOB:
Social Security No:
If applicant is a not for profit, corporation, partnership or other business entity, please identify:
Name of Business Entity:
Type of Ownership:
Federal Tax Id: Start Date:
Mailing Address:
2504 Broad St, San Luis Obispo, CA 93401
004-923-021 C-R
Malante Hayworth
Co-Chief Executive Officer
Coastal Retail SLO, LLC
Limited Liability Company
819 Reddick St, Santa Barbara, CA 93103
Coastal Retail SLO, LLC
01/23/201983-1
Primary Phone No: Alt. Phone No:
Email Address:
Preferred method of contact (check one) Mail Phone Email
E. Additional Responsible Party Information
Name:
Title: 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:
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.
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.
Julian Michalowski
Co-Chief Executive Officer
See attached
California Coastal Investments, LLC
2436 Broad St, San Luis Obispo, CA 93401
m
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.
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, proceedi ngs, 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 filling 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
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)
Coastal Retail SLO, LLC
San Luis Obispo Cannabis Commercial Business Operator Permit Application
E. Additional Responsible Party Information
E. Additional Responsible Party Information
Name: Josh Ginsberg
Title: Chief Operating Officer
DOB:
Social Security No:
Mailing Address:
Primary Phone No:
Alt. Phone No:
Preferred method of contact: Email
Name: Kimberly Moffatt Jones
Title: Advisory Board Chair
DOB:
Mailing Address:
Email Address:
Preferred method of contact: Email
Name: Eric Newton
Title: Project Director
DOB:
Social Security No:
Mailing Address:
Primary Phone No:
Alt. Phone No:
Email Address:
Preferred method of contact: Email
1
oastal Retail SLO, LLC
San Luis Obispo Cannabis Commercial Business Operator Permit Application
E. Additional Responsible Party Information
Name: Rodessa Newton
Title: Community Director
DOB:
Social Security No:
Email Address:
Preferred method of contact: Email
Name: Kelsi Bonzi
Title: Sustainability Coordinator
DOB:
Social Security No:
Mailing Address:
Email Address:
Preferred method of contact: Email
Name: Jennifer Jacobsen
Title: Account Manager
DOB:
Social Security No:
Preferred method of contact: Email
2
Coastal Retail SLO, LLC
San Luis Obispo Cannabis Commercial Business Operator Permit Application
E. Additional Responsible Party Information
Name: Lucy Matthews
Title: Community Coordinator
DOB:
Social Security No:
Mailing Address:
Email Address:
Preferred method of contact: Email
3
oastal Retail SLO, LLC
819 Reddick St, Santa Barbara, CA 93103