220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home Planning and Building Agency
Cannabis Division
CANNABIS LICENSE APPLICATION
ALL FEES ARE NON-REFUNDABLE – THIS APPLICATION IS A PUBLIC RECORD Application Number Date
To be filled out by City To be filled out by City
Applicant Name: _____________________________________
Check each that applies:
Cannabis Application Fee
Initial ܆ $18,644.85
Quarterly Compliance Inspection ܆ $550.00
Annual Renewal *** ܆ $14,107.85
Entity Transfer or Modification** ܆
TOTAL FEES
Application Activities (mark all that apply):
܆ Cannabis Cultivation ܆ Cannabis Manufacturing*
܆ Cannabis Distribution / Transportation ܆ Cannabis Testing ܆ Cannabis Dispensary ܆ Non-store Front Delivery
*For Manufacturing, circle one: Volatile Non-Volatile
**For a transfer of one person or entity to another, original permit holder must submit a signed and dated letter on professional letterhead detailing his/her intention to be removed from the business and permit.
***Annual Regulatory Fee included. For an Annual Renewal Permit submit the following: Completed Application; Updated Live Scans; Proof that Business License taxes and Cannabis taxes have been paid and are up-to-date; One, 8.5” x 11” Site Plan and Floor Plan identifying the location of cannabis activities and showing the exact square footage of each cannabis activity. Include permit numbers.
An inspection by City Staff is required prior to issuance of the Annual Renewal.
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0008 03-29-2022
$19,194.85
Quality Life Inc. / Michael Wilhoit
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home Please print the following information and attach the conditions of approval for each permit you list:
Conditional Use Permit Application Number (required before operation):
_________________________________________________________ Other related permits (previous cannabis applications, location development plan, etc.):
_________________________________________________________ I.
Application Information
Name of Business: _________________________________________________ Applicant entity structure:
܆ Corporation
܆ Unincorporated Association
܆ Other (described): _______________________________________________ II.
Applicant (Entity Name) ______________________________________________ Applicant Representative & Title: ______________________________________ ______________________ (this is the person who will be listed on the permit when it is issued, and whom the planning department will contact regarding this application)
Address: ____________________________________________________________ City: ___________________________ State: ____________ Zip: ______________ Telephone: _____________________________ Email: ___________________________________ Cellphone: ________________________________
III.
Location / Property Information
Facility address (issued by City of Barstow. If there are multiple addresses, list them all):
______________________________________________________________ ______________________________________________________________ Assessor’s Parcel Number (Issued by San Bernardino County Assessor): ______________________________ Zip Code: __________________________
Total square-Feet of each structure on site: ____________________________________ IV.
Property Owner information
Recorded Owner: ______________________________________________________ Address: ____________________________________________________________ City: ___________________________ State: ____________ Zip: ______________ Telephone: _____________________________ Cellphone: ___________________________________ V.
Criminal Convictions
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PCUP-22-0006
Cannabis storefront retail, 2841 Lenwood Rd., #2, Barstow, CA 92311 Quality Life Inc.
Quality Life Inc.
Michael Wilhoit, CEO
1305 W. Main Street
Barstow CA 92311
760-447-1880 [email protected]
760-447-1880
2989 Lenwood Rd., Suite 1, Barstow, CA 92311
92311
0421-313-58 & 0421-313-55
American Quartz Group, Inc.
2979 Lenwood Rd.
Barstow CA 92311
760-957-8888 760-957-8888
None.
5,000
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home Please list any felony criminal convictions or misdemeanor convictions involving moral turpitude, or the illegal use, possession, transportation, distribution, or similar activities related to controlled substances. Please list offense, date of offense, date of conviction, and City in which conviction occurred:
1. __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________
2. __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________
3. __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________
4. __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________
VI.
Unfair Business Practices
For any Applicant or Managing Member, please list all unlawful, fraudulent, unfair, or deceptive business acts or practices:
1. ___________________________________________________________________________________ ___________________________________________________________________________________ _______________________________________________
2. ___________________________________________________________________________________ ___________________________________________________________________________________ _______________________________________________
3. ___________________________________________________________________________________ ___________________________________________________________________________________ _______________________________________________
Business Entity Information
Appropriate Entity: ܆ Nonprofit ܆ Not-for-profit ܆ For-Profit Name of Corporation or LLC
Cal. Sec. of State Corp. ID No:
Federal Tax ID No:
Date of Incorporation:
Place of Incorporation:
Location of Corporation Headquarters:
Is this a Mutual Benefit Corporation? ܆ YES ܆ NO
Are all members of the corporation Qualified Patients and Designated Primary Caregivers of the Qualified Patient members?
܆ YES ܆ NO
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None
None
Quality Life Inc.
C4807533
32-0671281
November 3, 2021
Carlsbad, California
Barstow, California
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home Corporate Officers:
Please provide the following information for each cannabis permit applicant Corporate Officer. Attach additional pages to the application if necessary. Those listed will be authorized to discuss matters of this application with the Planning Department. Corporate Officers and Delivery Drivers must be recorded by the California Secretary of State.
All corporate officers and non-store front delivery drivers shall submit a live scan, failure to do so may result in delayed processing of this application.
Name (First, MI, Last) Title Phone
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Michael A. Wilhoit CEO 760-447-1880