Medical Marijuana Activity Zning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing COMMUNITY DEVELOPMENT DEPARTMENT / PLANNING DIVISION 8130 Allisn Avenue, La Mesa, CA 91942 Phne: 619.667.1177 Fax: 619.667.1380 All items listed n this frm and the Cnditinal Use Permit Applicatin shall be submitted t request authrizatin f a facility as described in the Medical Marijuana Activity Zning Ordinance. The facilities in this Supplemental Applicatin Packet are fr a specific Medical Marijuana facility type (ne f three) nly. All requested items and authrizatins listed n this frm must be cmpleted and submitted r the applicatin will be rejected. Please refer t City f La Mesa Standard Criteria and Additinal Criteria BEFORE cmpleting this applicatin. This request is fr authrizatin f land use nly and if apprved, cnditins f apprval must be cmpleted prir t cnducting business. An applicatin is restricted t ne facility in ne lcatin. The applicant shall demnstrate that the prpsed prject cmplies with the Medical Marijuana Activity Zning rdinance by addressing in the submitted materials fr the Cnditinal Use Permit request all f the Standard Criteria (Attachment 1) and Additinal Standard Criteria (Attachment 2) typically assciated with the specific facility type. Attach additinal pages as needed t prvide the infrmatin requested. The City will first review Sectin A materials fr clearance and the applicant will be ntified in writing f the status f Sectin A. Fees fr Sectin B will nt be accepted until Sectin A has been prcessed and the applicant has been ntified. All applicatins must be submitted in persn. It is the respnsibility f the applicant t ensure that all pages are included in the applicatin package and that the applicatin is cmplete when submitted t the City f La Mesa Planning Department. The applicant will be ntified as t the cmpletin status f the CUP applicatin. The applicatin must be deemed cmplete in rder t schedule a date fr the Planning Cmmissin meeting and public hearing. The infrmatin prvided t cmplete this applicatin may be subject t disclsure pursuant t the Califrnia Public Recrds Act. Fees The supplemental applicatin includes three Sectins (A-C). The fees shall be paid by cashier s check, mney rder r cash. The City prefers the fees t be paid by cashier s check r mney rder. Separate fees fr the fllwing individual prcesses are as nted r referenced in the adpted Fee Schedule. Sectin A. Initial Clearance CUP Initial Applicatin nn-refundable fee: $1,200 Sectin B. General Applicatin Remaining balance f CUP Applicatin nn-refundable fee: $10,178 Initial Plice Backgrund check: $106.00 per emplyee Live Scan fingerprinting prcess: third party r Plice Department $69 Envirnmental Assessment/Initial Study Applicatin: refer t fee schedule Sectin C. Medical Marijuana Maintenance and CUP Inspectin Reprts CUP Inspectins: $1,859 annually Annual Plice Backgrund $33 per emplyee Medical Marijuana Maintenance Reprts: $18,800-24,480 annually Page 1 f 7
The applicatin submittal must include Sectin A and Sectin B materials upn submittal. Sectin A. INITIAL CLEARANCE Prperty Owner/Building (Management) Authrizatin with ntarized signatures Prf f pssessin f the premises and apprval f use (deed, lease, lease assignment) Zning Clearance Distance Requirement Cmpliance (Dispensaries and Cultivatin Sites) Fees Sectin B. GENERAL APPLICATION Submit Cpy f City Letter shwing apprval f Sectin A. Initial Clearance Submit remaining Fee Balance due t upn apprval f Sectin A. Initial Clearance Evaluatin will cntinue n the fllwing submitted items upn submittal f the tw items abve. Cmpleted Cnditinal Use Permit Applicatin and Supplemental Applicatin Packet A signed cpy f La Mesa Standard Criteria (Attachment 1) and Additinal Standard Criteria (Attachment 2) fr the prpsed facility type in the CUP applicatin acknwledging that yu have read, understand the criteria and the prject will cmply with the criteria. Operating Prcedures including supplemental pages as needed. Fr an applicant with 20 r mre emplyees, prvide a statement that the applicant will enter int, r demnstrate that it has already entered int, and abide by the terms f a labr peace agreement. Structure f prpsed business, e.g., sle prprietrship, crpratin, LLC, partnership - include dcumentatin which shws bylaws, articles f incrpratin, etc. Live Scan Frm (prcessed) r receipt frm Live Scan check. If the prpsed business is publicly traded submit an Ownership Statement f every persn with ver 5% cntrlling interest. Site Plan (cpy f the same ne submitted fr CUP) including infrmatin shwing cmpliance t La Mesa Municipal Cde Chapter 24.23). Flr Plan (cpy f the same ne submitted fr CUP) including infrmatin shwing cmpliance t La Mesa Municipal Cde Chapter 24.23. A fire flw analysis shall be submitted by the applicant frm Helix Water District and dated within last thirty days f the general applicatin submittal date t determine the available fire flw in the existing public water system. Cpy f Bard f Equalizatin Seller s Permit (Business and Prfessins Cde 19322 (a) (7) Applicant Certificatin saying all infrmatin cntained n all applicatin dcuments is true and accurate. Envirnmental Assessment/Initial Study Applicatin C. MEDICAL MARIJUANA MAINTENANCE & CUP INSPECTION REPORT Staff Use Only Maintenance Inspectin Reprts and Fees Page 2 f 7
Cmplete all sectins identifying same persn(s) where apprpriate. All signatures must be ntarized and pages attached. Prvide prf f pssessin f the premises, legal right t ccupy and apprval f use (deed, lease, lease assignment). Prperty Owner Affidavit I,, authrize the Medical Marijuana Facility entitled, t use this prperty as a Medical Marijuana facility fr, as thse terms are defined in the La Mesa Municipal Cde, shuld this facility btain a Cnditinal Use Permit. I further understand that I am respnsible fr, and als subject t, enfrcement actins regarding any vilatins and/r nuisance activity which may ccur at this prperty. Legal Prperty Owner: Date: Name (Please print) Title: Signature Legal Building Owner: Date: Name (Please print) Title: Management: Signature Name (Please print) Date: Title: Signature Building (Management) Affidavit I,, authrize the Medical Marijuana Facility entitled (Name f Business listed n frm), t use this prperty as a Medical Marijuana facility, as thse terms are defined in the La Mesa Municipal Cde, shuld this facility btain a Cnditinal Use Permit. I further understand that I am respnsible fr, and als subject t, enfrcement actins regarding any vilatins and/r nuisance activity which may ccur at this prperty. Page 3 f 7
Prpsed Name f Business: Dcumentatin f Business Organizatin: (attach prf f status such as articles f incrpratin, by-laws, partnership agreements, and ther dcumentatin that supprts status). Select all that apply: Unincrprated Assciatin Sle Prprietr Prvide Fictitius Business Name Statement (if different than wner s name) Crpratin Prvide Articles f Incrpratin and Crprate Bylaws LLC Prvide Articles f Organizatin and Operating Agreement Partnership Prvide Partnership Agreement Other (describe): Prvide an Ownership Statement f every persn with ver 5% cntrlling interest in the prpsed business if the cmpany is publicly traded. Primary Cntact (Print Name): Title: Primary Cntact Address: Telephne: Email: Mbile: Additinal Prperty and Business Infrmatin: Medical Marijuana Facility Address: Assessr s Parcel Number: Zne: Occupancy type f existing Structure (CBC, Chapter 3): Prpsed Occupancy type (CBC, Chapter 3): Date f the cnstructin f the existing structure: Identify water supplier: Page 4 f 7
OPERATING PROCEDURES DOCUMENTS Prvide a detailed descriptin f the applicant s perating prcedures fr all f the fllwing. Attach dcuments n clearly labeled separate sheets f 8-1/2 x 11 f paper. 1. Extractin and infusin methds 2. The transprtatin prcess 3. Inventry prcedures 4. Quality cntrl prcedures 5. Security prtcls APPLICANT CERTIFICATION Under penalty f perjury, I declare that I have persnal knwledge f the infrmatin stated in this applicatin and that the infrmatin cntained herein is true, crrect and cmplete. By submitting this applicatin, I certify that I have read and understand the requirements f the applicatin prcess and that I may be disqualified fr failure t meet the requirements f state law r City rdinance, r fr incmplete, late r inaccurate applicatins/attachments, and that all fees paid in cnnectin with this applicatin are nn-refundable. Applicant: PRINT NAME Signature f Applicant Date: REVOCATION A Cnditinal Use Permit fr a manufacturing site may be revked r suspended due t legitimate litering cmplaints, nise cmplaints, upn City cnfirmatin f the smell r litering nuisance, r nn-cmpliance with the Cnditinal Use Permit, r nn-cmpliance with ther applicable state r lcal regulatin. The licensee shall have a reasnable pprtunity and time t cure the cmplaint r pssible nn-cmpliance as defined in the Standard and Additinal Criteria befre being subject t revcatin r suspensin. A cnditinal use permit may be revked by the Planning Cmmissin if it determines that the permit was btained thrugh fraudulent representatives r the use was subsequently changed in peratin cntrary t representatins r cnditins applied. (LMMC 24.02.060 - Cnditinal Use Permits). Page 5 f 7
MANUFACTURING SITE Eligible Znes: Industrial Services and Manufacturing (M) Prhibited in Residential Znes Extractin f cannabis cncentrates with vlatile slvents is prhibited. N public access r sales is allwed n the premises. Additinal Submittal Requirements fr Manufacturing Site Requests Submit a lighting plan with a phtmetric analysis shwing the illuminatin f the interir f the dispensary, façade and the immediate surrunding area including any accessry uses, parking lts and adjining sidewalk. Submit a Hazardus Materials Management (HMMP) and submit with the plans fr review by the Fire Department. Submit the light fixture manufacturer s sheets fr each fixture type illustrating integral shield, hds, r ther methds that cntrl the light emissins and deflect light away frm adjacent prperties. Identify security measures t be implemented including but nt limited t: perable cameras, alarms, and a Licensed Security Guard. Evidence that a Califrnia State Licensed Security Guard has been cntracted fr the Business. All emplyees f the rganizatin are subject t a backgrund check and evidence must be submitted prir t prceeding t the Cnditinal Use Permit public hearing. Submit evidence that at least ne wner, directr, fficer, manager r emplyee has passed a stateapprved fd safety certificatin exam if edible cannabis prduct is prpsed t be prduced n the premise. Submit a cpy f the Class B Permit fr a Califrnia licensed cmmercial kitchen r a cttage kitchen if the prject includes a request t prduce edible cannabis prducts that require baking r refrigeratin. Submit a site diagram and flr plan in a frmat that shws cmpliance t all minimum standards fr City f La Mesa Municipal Building and Fire Cde requirements fr the prpsed ccupancy type. Attach: Prf f status as a qualified patient r primary caregiver (State card r dctr recmmendatin) Tw frms f Pht Identificatin f Applicant(s) (issued ID/driver s license, passprt, State issued identificatin card) Prf f address (DMV issued ID/driver s license, and/r recent utility bill under Primary s name) Attachment 1: Standard Criteria fr Manufacturing Attachment 2: Additinal Standard Criteria fr Manufacturing Page 6 f 7
STAFF USE ONLY C. CUP INSPECTION AND MEDICAL MARIJUANA MAINTENANCE REPORT Type f Facility Cnditinal Use Permit # Facility Address Name f Primary Cntact Primary Cntact Email Primary Cntact Phne Mailing Address CUP MAINTENANCE INSPECTION REPORTS (See attached Reslutin f Apprval #XXXX-XX) CUP Apprval 1 st Annual Fee 2 nd Annual Fee 3 rd Annual Fee 4 th Annual Fee Date Crrectin Issued? Date Applied Fee Paid DISPENSARY MONITORING AND COMPLIANCE 1) Standard Facility Inspectin (includes emplyee verificatin, track and trace verificatin, labelling verificatin, facility inspectin, etc.) Prpsed Frequency Mnthly 2) Independent Prduct Third-Party Testing (ptency and cntaminate testing) Prpsed Frequency 4 samples per mnth 3) Vide Mnitring (randm auditing) Prpsed Frequency 4 hurs f randm audit per mnth CULTIVATION MONITORING AND COMPLIANCE 1) Standard Facility Inspectin (includes emplyee verificatin, track and trace verificatin, fertilizer and pesticide verificatin, purchase rder verificatin, facility inspectin, etc.) Prpsed Frequency Mnthly 2) Independent Prduct Third-Party Testing (ptency and cntaminate testing) Prpsed Frequency 4 samples per mnth MANUFACTURING (NON-VOLATILE) MONITORING AND COMPLIANCE 1) Standard Facility Inspectin (includes emplyee verificatin, track and trace verificatin, labelling verificatin, prcess verificatin, facility inspectin, etc.) Prpsed Frequency Mnthly 2) Independent Prduct Third-Party Testing (ptency and cntaminate testing) Prpsed Frequency 8 samples per mnth Page 7 f 7