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HomeMy WebLinkAboutSLOCal Roots Application FormCITY OF SAN LUIS OBISPO Community Development Department 919 Palm Street, San Luis Obispo, CA 93401 805.781.7170 Commercial Cannabis Business Operators Permit Application Business Name: ! Lo (f-nA-L**..e Property Address: Assessor Parcel Number: (,'IS *3 — 2,.S 6— 407 Zoning Designation: B. Business p- pp 7]—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) Manufacture (Non-volatile Raw Manufacture (Cannabis Infusion) Manufacture (Itinerant — No Product Extractionpermanent facility) Manufacturer (Research and Distributor Testing Laboratory Development) 4A.Retailer Storefront (Adult -use) tailer 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% Microbusiness (More than 50% GR* GR* from cultivation, distribution from cultivation, distribution and and manufacturing) manufacturing) 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: Title: ! ' DOB: Social Security No: Ifapplicant is anot for profit, corporation, partnership or other business entity, please identify.- Name of Business Entity: 6/0 p, t rg-boof5 p lw j LPL Type of Ownership: G,;n. 7 G ,,lil,j i 7j LOB,,, I Ay Federal Tax Id: Start Date: 10 Mailing Address: S 9 oa i - ; 6 P C ? 'z/D rimaryPhoneNo: Alt. Phone No: Email Address: Preferred method of contact (check one) Mail Phone (%Email E. Additional Responsible Party Information Title: DOB: Social Security No: Mailing Address: Primary Phone No: Alt. Phone Email Address: Preferred met contact (check one) Mail Phone Email attach additional sheets if there are more than 2 Responsible Partles, Email Address: Preferred method of contact (check one) Mail PhoneEmail 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. G. Related License Information The applicant and/or responsible parties has been associated with a commercial cannabis business permit in the past 10 years. E.Yes E] No (If yes, please provide the following information) A Name: i-116+cn OWn G li... City or County:S Start Date: End Date:%-75- Business Name:Business Type: ifyM }:„Cefii._ Or Please attach additional sheets if necessary. N i • • • • • 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. 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. Is Indemnification FI, 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. J0 Nonrefundable Filing 'Fee I, the applicant, understand and accept that the nonrefundable filling fee must be submitted with the competed omm4ercial Cannabis Business Operators Permit Application and will be retained by the City regardless of the out- come of the application review. VJ 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) bnlicant's Certificati 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 penalty of perjury under the laws of the State of California, that I have personal knowledge of the information contained this application hat the information contained herein is true and correct. Signature: Date: e?- The information contained on this document is subject to disclosure under the Public Records Act, Applicants pro viding 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 requirements 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 regarding application completeness TVT 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 owners authorized representative, granting the applicant permission to apply for a cannabis business operator permit, I, the undersigned legal owner of record, hereby grant permission to: Applicant-, C) Q. Mailing Address- --'3 5, 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,, k e Assessor"s Parcel Number: 4(1 46) 0 See Attached Certificate 10W 1 44 Z k,dA1 1111iol57 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 of A On before me Dote Here Insert Name and Title of the Officer e 4, personallyappearedName( s) c'Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. M. AM- ML All Imi Mir Cox California NotaryPub'ic San Luis Obispo County Commission z 2265076 4010% My r dm;m. Expitres Oct 29, 2022 In, I- MWI- I Place Notary Seal andlor 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 Signature of Notary Public 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 Document: Document Date: Signer( s) Other Than Named Above: Capacity( les) Claimed by Signer(s) Signer' s Name: 11 Corporate Officer — Title(s): 0 Partner — n Limited El General El Individual El Attorney in Fact n Trustee n Guardian of Conservator 11 Other: Signer is Representing: 02017 National Notary Association Number of Pages: Signer' s Name: o Corporate Officer — Title(s): El Partner — 11 Limited n General 1: 1 Individual 0 Attorney in Fact r- 1 Trustee o Guardian of Conservator El Other: Signer is Representing: