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HomeMy WebLinkAboutNatural Healing Center Application FormCITY OF SAN LUIS OBISPO Community Development Department r' 919 Palm Street, San Luis Obispo, CA 93401 805.781.7170 r Commercial Cannabis Business Operators Permit App rron A. Business Information Business Name: Natural Healing Center - SLO Property Address: 2600 & 2640 Broad Street, San Luis Obispo, CA 93401 Assessor Parcel Number: 004-925-033 & 004-925-034 Zoning Designation: C-R 004-925-035 (Proposal Will Merge Lots) B. Business •apply) Cultivation - Specialty (Up to 5,000 Cultivation - Small (5,001 - 10,000 Cultivation - Nursery (Up to 10,000 Sq. Ft. Max Sq. Ft. Max) Sq, Ft. Max) El Manufacture (Non-volatile Raw Manufacture (Cannabis Infusion) El Manufacture (Itinerant --No Product Extraction permanent facility) LJ Manufacturer (Research and Distributor Testing Laboratory Development) Retailer Storefront (Medical) El Retailer Storefront (Adult -use) Retailer Storefront (Adult -use and Medical) Retailer Non -storefront (Adult -use) I Retail Non -Storefront (Medical) Retail Non -storefront (Adult -use and Microbusiness (No more than 50% Medical Transporter Microbusiness (More than 50% GR* GR* from cultivation, distribution from cultivation, distribution and and manufacturing) manufacturing) vI uaz nC4r_IPLZ 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 1011/6 of the stock, capital, profits, voting rights, or membership interest of the comITIercial 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: Helios Dayspring Title: Managing Member/CEO DOB: 05/ Security No: 564- applicant is a not for profit, corporation, partnership or other business entity, please identify Name of Business Entity: NHC SLO LLC Type of Ownership: Limited Liability Company Federal Tax Id: 83-Date: 12/11/2018 Mailing Address: 7510 Los Osos Valley Rd, San Luis Obispo, CA 93405 Primary Phone No: Email Address: Preferred method of contact (check one) Alt. Phone No: Mail ® Phone Email E. Additional Responsible Party Information Nicholas- Title: COO Snrinl Sarurity Nn• Mailing Address: Primary Phone No: Email Address: DOB: Alt. Phone No: Preferred method of contact (check one) Mail ® Phone ® Email Please attach additional sheets if there are more than 2 Responsible PartiesF. Information on Property Owner or Landlord Name: CK Gilbert LLC / CCKL Broad LLC Keith Sweeney) Please note: Helios Dayspring has an executed purchase agreement for these properties. Mailing Address: 225 Ranchito Lane, SLO & 1305 Garden St, SLO 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 Owners Statement of Consent to operate a commercial cannabis business on the property. InformationG. Related License 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: Helios Dayspring City or County: San Luis Obispo County Start Date: 11/01/2011 End Date: 12/31/2018 Business Name: House of Holistics Corp. Business Type: Medical Delivery Service Please attach additional sheets if necessary. — Please see Section 1.05: State Licenses of the accompanying application for other cannabis business permit information. 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. 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. f 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. 1. 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) M. Applicant's Certification I agree to abide by and conform to the conditions of the permit and all provisions of the San Luis Obispo Municipal Code pertaining to the establishment and operation of the commercial cannabis business. I acknowledge that the approval of the Commercial Cannabis Business Operators Permit shall, in no way, permit any activity contrary to the San Luis Obispo Municipal Code, or any activity which is in violation of any applicable law. I certify under pe alty of perjury under the laws of the State of California, that I have personal knowledge of the information co d pplication and that the information contained herein is true and correct. signature: 9 Date: 01/29/2019 The information cvntained thi doument is subject to disclosure under the Public Records Act. Applicants providing false or misleading information in the Permitting process will result in rejection of the application and/or nullification or revocation of any issued permit. All commercial cannabis Permits must be approved by the City Council. The City may attach conditions to the permit. A commercial cannabis permit may be denied if any of the following findings are made: i) The application does not meet all r-equirements of the commercial cannabis ordinance; or ii) Approval would very likely result in harm to public safety, health, or welfare, or iii) Potential negative impacts of the use cannot be mitigated with conditions or through the ordinance requirements. Applicants will be notified rega1ding application cnpipleteness OMMERCIAL CANNABIS BUSINESS OPERATORS PERMIT APPLICATION OWNER'S STATEMENT OF CONSENT If the applicant is not the owner of record of the subject site, the following Statement of Consent must be completed by the owner or the owner's authorized representative, granting the applicant permission to apply for a cannabis business operator permit. I, the undersigned ynedlegalownerofrecord, here /grant permission to: Applicant: G e It`o S oL f r`/I I OG Phn e: LG 1 f Mailing Address: 516 03 OSss VAIle fz -50LiL La(s t fS o, C.14 q'jYUS To operate a commercial cannabis business on the property described below. I agree to abide by and conform to the conditions of the permit and all provisions of the San Luis Obispo Municipal Code pertaining to the establishment and operation of the commercial cannabis business. I acknowledge that the approval of the Commercial Cannabis Business Operator Permit shall, in no way, permit any activity contrary to the San Luis Obispo Municipal Code, or any activity which is in violation of any applicable law. The subject property is located at: 2b0o 26 c4p sZoD CS -a--- Assessor' s Parcel Number: b O 72S 633 Printed Name of Owner of Record: 'L [ t 2 L Address of Owner of Record: 22- Attached Certificate CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County o 1--,M.C 3 On 11 I' before me, 1 . Date Here Insert Name and Title of the Officer personally appeared Name(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Oare subscribed to the within instrument and acknowledged to me that W/ffe/they executed the same in highkt2r/their authorized capacity(ies), and that by l is+erhheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. T. Cox a Notary Public • California i San Luis Obispa County Commission p 2265076 My Comm. Expires Oct 29, 2022 r.. Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Sig ature of Notary Public OPTIONAL -- Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Docum ern . "/ n V?Z T' 4DocumentDate: t Lb a Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian of Conservator Other: Signer is Representing: 02017 National Notary Association Signer's Name: Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian of Conservator Other: Signer is Representing: