DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 1 of 68
THE CITY OF
O BARSTOW
CROSSROADS OF OPPORTUNITY
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: Grow Organic 5, Inc
-
Check each that applies:
Cannabis Application Fee
Initial 1 $18,644.85
Quarterly Compliance Inspection • $550.00
Annual Renewal *** $14,107.85
Entity Transfer or Modification**
TOTAL FEES $18,644.85
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" × 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. 220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 2 of 68
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.):
Application Information
Name of Business: Grow Organic 5, Inc
Applicant entity structure:
• Corporation
• Unincorporated Association
• Other (described):
Il.
Applicant (Entity Name) Grow Organic 5, Inc
Applicant Representative & Title: Raymond Mirzabegian owner (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:_2837 Lenwood Rd, Barstow, CA 92311
City: _ Barstow State: CA Zip: 92311
Telephone:818-482-0358 Email: _ [email protected] Cellphone: 818-482-0358
III.
Location / Property Information
Facility address (issued by City of Barstow. If there are multiple addresses, list them all):
2837 Lenwood Rd, Barstow, CA 92311
Assessor's Parcel Number (Issued by San Bernardino County Assessor): 0428-211-26-0000 Zip Code: _92311
Total square-Feet of each structure on site: 18,711 soft Iv.
Property Owner information
Recorded Owner: _Barstow Outlet, LLC
Address: _910 Broadway, Ste 110. Santa Monica, Ca 90401 City: Santa Monica State: CA Zip: 90401
Telephone: 310-451-4500 Cellphone: 310-451-4500
V.
Criminal Convictions
NONE
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 3 of 68
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. NONE
2. 4.
VI.
Unfair Business Practices
For any Applicant or Managing Member, please list all unlawful, fraudulent, unfair, or deceptive business acts or practices:
1. NONE
2. 3.
Business Entity Information
Appropriate Entity: • Nonprofit • Not-for-profit & For-Profit Name of Corporation or LLC Grow Organic 5, Inc
Cal. Sec. of State Corp. ID No: 5017832
Federal Tax ID No: 88-1800343
Date of Incorporation: 04/12/2022
Place of Incorporation: California
Location of Corporation Headquarters: 3795 La Crescenta Ave #101 Glendale, CA 91208 Is this a Mutual Benefit Corporation? • YES *I NO
Are all members of the corporation Qualified Patients and Designated Primary Caregivers • YES O NO of the Qualified Patient members?
220E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 4 of 68
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
Raymond Mirzabegian owner 818-482-0358
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 5 of 68
BARSTOW PROPERTY OWNER / LANDLORD USE DISCLOSURE & AUTHORIZATION FOR
A CANNABIS FACILITY
If the applicant is the owner of the property on which this activity is located, the applicant shall provide a copy of the title or deed to the property. If the applicant is not the owner of the property, this form shall be filled out and a copy of the contractual agreement between applicant and owner included.
Barstow Outlet, LLC , am the legal Owner / Landlord / Lessor or real (Name of Property Owner / Landlord) (Circle Appropriate Term) Property located at 2837 Lenwood Rd, Barstow. CA 92311 , in Barstow, California.
I hereby authorize the Cannabis Applicant entitled
Grow Organic 5, Inc _ to use this property as a
(Name of Corporation, Individual, or Business)
cannabis facility, as that term is defined in state law and by the City of Barstow Municipal Code, for the specific use of a cannabis facility.
Farad Aborat Property Manager + Authorizzel Agent for Owner (Printed Name & Tide)
(Signature of Legal Owner / Landlord / Lessor)
310-451-4500 910 Broadway, Ste 110, Santa Monica, Ca 90401 -
(Phone Number) (Address)
12/9/2022
(Copy and attach additional pages of this form if necessary to include multiple Owners) All Signatures must be original, no electronic signatures, or copies will be accepted. 1, - Raymond Mirzabegian _ declare under penalty of perjury that the foregoing 6th day of December
Information is true and correct. Executed this _ 20]
220E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 6 of 68
ACKNOWLEDGEMENT OF CANNABIS OPERATING STANDARDS AS SET FORTH IN
BARSTOW'S MOST RECENT CANNABIS ORDINANCE
The undersigned Management Members, on behalf of the herein Cannabis Operation I, permit applicant, _ Raymond Mirzabegian, Grow Organic 5, Inc _ declare under penalty of perjury that I have read and understand the provisions of Barstow's most recent cannabis ordinance, and shall, collectively and individually, ensure that the Cannabis Applicant, its Members, and Management Members shall not engage in activity that violates the Operational Requirements set forth in Barstow's most recent cannabis ordinance, which states in relevant part that the Cannabis Applicant shall:
(A) Only Operate on a property located within the zoning districts specified by Barstow Municipal Code sections 19.16.030 and 19.18.030, as applicable.
(B) Not be located within a 1,000-foot radius of any public or private school providing instruction in kindergarten or any grades one through twelve, public park, public day care center or youth center, or church or other religious land use that in in existence at the time the Cannabis Business applies for its initial Permit.
(C) Not be located within 1,000-foot radius of any residentially zoned district of the City (Districts ER, LDP, SFR, MDR or any other newly created residential zoning district) that is so zoned at the time the Cannabis Business applies for its initial Permit.
(D) Comply with all City laws and all other applicable laws. (E) Comply with all applicable provisions of Business & Professions Code Section 26000, et seq. and all applicable rules and regulations promulgated by the State Licensing Agencies. (F) Designate one of its Owners or full-time employee as its Community Relations Liaison and who shall be responsible for receiving and responding to all concerns and complaints made to the City regarding the Cannabis Business and for making a good faith attempt to promptly address all concerns and resolve all complaints. The Community Relations Liaison's name, phone number, and email address shall be posted prominently on the exterior of the Cannabis Business's Business Premises. (G) Individuals under 21 years of age shall not be allowed on the Business Premises of any Cannabis Business, except as pertaining to the sale of cannabis for medicinal use by a Storefront Retail Cannabis Business to a medical patient or primary caregiver who is at least 18 years of age. (H) A Retail Storefront Cannabis Business shall only be open to the public between the hours of 6 a.m. and 10 p.m. A Delivery Cannabis Business shall only deliver Cannabis or Cannabis Products between the hours of 6 a.m. and 10 p.m. The City Manager may adjust these default hours by regulation. 220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 7 of 68
(I) Implement sufficient security measures to deter and prevent the unauthorized entrance into areas containing Cannabis or Cannabis Products, and to deter and prevent the theft of Cannabis or Cannabis Products. These security measures shall include, but may not be limited to the following:
1) Alarm system (perimeter, fire, and panic buttons)
2) Remote monitoring of alarm systems by licensed security professionals 3) Perimeter lighting systems (including motion sensors) for after-hours security 4) Perimeter security and lighting
5) Establishing limited access areas accessible only to authorized Cannabis Business personnel 6) All Cannabis and Cannabis Products shall be stored and secured in accordance with the requirements specified by the State of California. All Cannabis and Cannabis Products, including live plants that are being cultivated, shall be kept in a manner as to prevent diversion, theft, and loss.
7) 24-hour security surveillance cameras to monitor all entrances and exits to and from the Business Premises, all interior spaces within the Cannabis Business which are open and accessible to the public, all interior spaces where Cannabis, cash or currency, is being stored for any period of time on a regular basis and all interior spaces where diversion of Cannabis could reasonably occur. Live feed and video recording shall be maintained for a minimum of 90 days. (J) Take reasonable steps to discourage persons on or around its Business Premises, including any parking areas under its control from engaging in illegal, criminal, or nuisance activities, including, but not limited to, disturbances of the peace, public intoxication, drinking alcoholic beverages, smoking or ingesting Cannabis Products, illegal drug activity, vandalism, obstruction of the operation of another business, harassment of passersby, gambling, prostitution, loitering, public urination, lewd conduct, drug trafficking, excessive loud noise, or any other behavior that adversely affects or detracts from the quality of life for adjoining residents, property owners, or businesses. (K) Provide immediate access to its Business Premises and all areas therein to employees or agents of the City performing their official duties.
(L) The City Manager or its designee may develop other operational requirements or regulations as are determined to be necessary to protect the public health, safety, and welfare. (M) Cannabis growing, manufacturing, and testing shall be in appealing and discreet facilities that do not openly advertise the presence of any cannabis products or operations on site and subject to City's Design Guidelines.
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 8 of 68
We, Barstow Outlet, LLC and Raymond Mirzabegian
(Printed Name of Property Owner) (Printed Name of Operator) Collectively acknowledge that we have been provided a copy of the cannabis facility operating standards listed on the City of Barstow's most recent cannabis ordinance. We further acknowledge that we have read, understand, and shall ensure compliance with the aforementioned operation standards and all applicable provisions of the City of Barstow's most recent cannabis ordinance at the time cannabis facility entitled Grow Organic 5, Inc
(Name of facility listed on the application)
We certify under penalty of perjury that the foregoing information is true and correct.
Executed this day of December 202022 _ in Barstow, California. (Month) (Year)
Farhud Abolfathi, Property Manager 4
Printed Name & Title Authorized Agent for Owner
PocuSkince by:
Raymond Mirzabegian. Raymond Mirzafeg tem
ignature of Operato Printed Name & Title
220E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 9 of 68
INFORMATION AND RELEASE FORM
The undersigned, on behalf of Grow Organic 5, Inc , hereby authorize the City of Barstow, by and (Name of Corporation)
Through its appropriate Officers, Agents, and Employees to verify and confirm the information contained in this application, and to conduct such other investigations as may be reasonably required by the City of Barstow, its Officers, Agents, and Employees for the purpose of determining the capability, fitness, and capacity of the above named Corporation to obtain the Cannabis Permit.
The Applicant by signing this Information Release Form consents to service of any notice required or provided for by the laws, rules, regulations, or ordinances of the City of Barstow upon the person(s) at the address listed for Applicant, will constitute sufficient and legal notice, unless said Applicant listed an Attorney of Record and/or Agent for service of process, with sufficient contact information.
The Applicant consents and agrees that full compliance will be made with all applicable State laws and City ordinances governing the conduct of the particular type of activity for which the Cannabis Permit re requested.
The Applicant by signing this Information Release Form understand that any complete or false information may constitute grounds for denial.
This form MUST be signed by each Applicant Management Member.
Raymond. Mirzabe gian. Raymond Mirappegean 12/6/2022
Signature of Märgement Member Printed Name & Title Date Signature of Management Member Printed Name & Title Date Signature of Management Member Printed Name & Title Date This release may be executed in two or more counterparts, each of which shall be deemed an original, and all of which taken together shall constitute one and the same instrument. All Signatures must be originals; no electronic signatures or copies will be accepted.
I declare under penalty of perjury that I have read the forgoing application and all information, statements, verifications, declarations, and authorizations made, attached to and contained herein, and that I have personal knowledge of the information contained in the application, and that the information contained and the application is true and correct, and that the application was completed under supervision of the Management Members. December
6th
Executed this day of 20 in Barstow, California.
(Month) (Year)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 10 of 68
BARSTOW CANNABIS FACILITY
ON-SITE MEMBER CONTACT STATEMENT
The undersigned, on behalf of Grow Organic 5, Inc
(Name of Corporation)
hereby designates Norair Madatian as the on-site
(Name of On-Site Manager)
Community Relation's Representative to whom the Public or City can provide notice to fi there are operating problems or issues relating to the Barstow Cannabis Facility. The Cannabis Facility shall make every good faith effort to encourage residents to call this person to try to solve operating problems, if any, before any calls or complaints are made to the Police or Planning Departments. -DocuSigned by:
Norair Madatian Norair Madatian , Member
Signature of On-Site Manager Printed Name & Title
12141 Lull St., North Hollywood. CA 91605 818-522-2220
Address Phone Number
[email protected]
Fax Number Email
I declare under penalty of perjury that I have read the forgoing application and all information, statements, verifications, declarations, and authorizations made, attached to and contained herein, and that I have personal knowledge of the information contained in the application, and that the information contained and the application is true and correct, and that the application was completed under supervision of the Management Members.
6th 2022
Executed this day of December .20. _ in Barstow, California. (Day) (Month) (Year)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 11 of 68
APPLICATION THE CITY OF
FOR 6 BARSTOW
CANNABIS BUSINESS
CONDITIONAL USE PERMIT CROSSROADS OF OPPORTUNITY
Application No: PCUP
Applicant Name Raymond Mirzabegian
Street Address 2837 Lenwood Rd, Barstow, CA 92311
City, State, Zip Code Barstow CA 92311
818-482-0358 Mobile Phone 818-482-0358
Home Phone
Work Phone 818-482-0358 Fax
E-mail Address [email protected]
Property Owner Barstow Outlet, LLC
Street Address 910 Broadway, Ste 110, Santa Monica, Ca 90401 City, State, Zip Code Santa Monica, Ca 90401
Home Phone 310-451-4500 Mobile Phone 310-451-4500
Work Phone 310-451-4500 Fax
E-mail Address [email protected]
Primary Contact Farhad Abolathi
Home Phone 310-451-4500 Mobile Phone 310-451-4500
Work Phone 310-451-4500 Fax
E-mail Address [email protected]
Anticipated Number of Employees Once in Operation 10
Project Location 2837 Lenwood Rd, Barstow, CA 92311
Legal Description
Existing Zoning of Property Commercial
Existing Zoning of Property Commercial
.frrt:ilgnerd loy
Paymen. d. Miro abe gian. 12/6/2022
Signature of Applicati Date
12/9/2022
Signature of Property Owner(s) if not same as Applicant Date Authorized
Signature of Property Owners) if not same as Applicant Date (Separate written authorization by property owner to submit application may be provided) 220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 12 of 68
CITY OF BARSTOW
COMMUNITY DEVELOPMENT DEPARTMENT PLAN SUBMITTAL REQUIREMENTS Seven (7) sets of the following plans in 24" × 36" size shall be submitted to the Community Development Department, unless otherwise noted or directed by staff. Plans shall be collated, stapled and folded to 8 ½½" x 11" unless colored. Plans are required to include, at a minimum, the following items at the time of submittal:
Notification Package: A notification package containing a scaled map or Assessor's Parcel Map pages showing all properties within a 300-foot radius of the subject property (including contiguously owned property); a typed list of the property owners and their mailing addresses within the 300-foot radius.
Submit three (3) sets of typed, self-adhesive, addressed labels for the above property owners.
2. Title Report: A Title Report of the subject property. Said report must be dated within the last six (6) months of the application submittal.
3. Existing Site Plan: Drawn to scale and fully dimensioned, showing the existing project site.
4. Proposed Site Plan: Drawn to scale and fully dimensioned, showing the proposed project site. Where applicable, include the following:
Proposed buildings, structures (trash enclosures, etc.) Driveways Dimensioned parking stalls Curbs, gutters, sidewalks
Truck loading areas • Location of fire hydrants
Air conditioning units • Back-up areas
Bicycle paths • Service areas
Easements • Accessible path of travel
Street lights • Perimeter and screen walls
Existing structures on abutting properties Available/proposed utilities A. Included on this plan shall be a table of tabulating the following: project area size in acres (gross and net), gross building square footage (individual and total), lot coverage ratio, hardscape square footage (parking areas and walks), landscaping square footage, required and proposed parking spaces, including accessible parking spaces and loading spaces.
B. If the project is going to be phased, indicate the limits of the phasing and all off-site improvements to be constructed with each phase. All project phasing must be provided at the time of the initial submittal and review. A phased project that is not disclosed up front may require the filing of a supplemental application with appropriate fees to defray the cost associated with additional city review and approval.
5. Conceptual Grading and Drainage Plan: A conceptual grading and drainage plan drawn to an engineering scale of no smaller than 1"=30' with the scale clearly labeled and shall include the following information:
A. Existing and proposed contours, pad elevations, adjacent street elevations, parking lot, driveways, landscaping, drainage patterns, dry wells, retention area, etc. (grading may be indicated on the site plan if clearly readable). Tabulations showing amount of cut/fill, lot sizes, number of lots, square feet/acres of each).
B. Areas subject to inundation.
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 13 of 68
6. Conceptual Architectural Renderings: Architectural plans shall be of sufficient size to show architectural detail and include the following:
A. Floor plans showing allocation of space and location of all door and window openings, four copies shall be submitted. Include parking and use calculations. See Section 19.06.050 of the Barstow Municipal Code for parking requirements.
B. Elevations shall be fully dimensioned and all colors, finishes and materials shall be identified on the plans. Color renderings may be required.
7. Exterior Lighting Plan: Plans shall show conceptual type of light fixtures including base, locations, fixture height, source, and surface illumination. Lighting plans shall demonstrate that the lighting fixtures are capable of providing adequate illumination for security and safety, including, without illumination, one (1) foot candles maintained across the surface of the parking area. Include fixture cut sheets and site/photometric plan with foot-candle calculations (min., max., average).
8. Conceptual Landscape Plan: The City of Barstow is located in the Mojave Desert and consideration shall be given to temperatures, wind, soils, shade, drainage, irrigation systems, and plant selection. This plan shall be drawn to an engineering scale no smaller than 1"=50' and shall include the following:
A. Landscape Plan: 24" x 36" (3 copies, folded).
B. Landscape legend with plant types, sizes and quantities shall be included on the plans.
C. The City of Barstow references Zone 11 of Sunset Magazine's Western Garden Book of Landscaping for plant materials.
9. An electronic copy of all of the above plans in "JPEG" or "PDF" format on either a Compact Disk or USB memory device.
10. Any special studies as determined by the Community Development Department, i.e.:
Negative Declaration
• Mitigated Declaration
• Environmental Impact Report
The following statement of findings and attached plans are offered to show:
A. That the use applied for at the location set forth in the application is properly one for which a conditional use permit is authorized by this title.
B. That the use is necessary or desirable for the development of the community and is not detrimental to existing uses or uses specifically permitted in the district classification as per this title. c. That the site for the intended use is adequate in size and shape to accommodate the use and that all of the yards setbacks walls or fences, landscaping, and other features required in order to adjust the use to existing uses or possible future uses on adjoining land in the neighborhood be compatible with one another.
D. That the site for the proposed use conforms to streets and highways property designed and improved so as to carry the type and quantity of traffic generated or to be generated by the proposed use.
E. City sewer service shall not be provided to any parcel not meeting the requirements of this chapter. 220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.ors/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 14 of 68 F. I understand that all conditions of approval on this project will be recorded at the San Bernardino County Recorders office.
G. Applicant's Statements:
I hereby understand approval of this Conditional Use Permit includes conditions and that failure to comply with those conditions will result in revocation of the Conditional Use Permit.
I further understand that representation is required at the meeting (either personally or by written confirmation of agreeing to all conditions) and that failure to have representation could result in the continuation of the hearing thereby delaying the approval process. 12/6/2022
Date
General Notes:
* An Environmental Information Form (Appendix G, attached) shall be submitted with each application. * Refer to Chapter 19.30 B.M.C. regarding voiding of this permit.
Please direct all questions regarding this application to:
City of Barstow
Cannabis Division
220 E. Mt. View St., Suite A
Barstow, CA 92311
(760-255-5161/[email protected])
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AAO72C68E033 REV 1/5/2022 Cannabis License Application Page 54 of 68
THE CITY OF
ENVIRONMENTAL
INFORMATION O BARSTOW
AND
CHECKLIST FORM CROSSROADS OF OPPORTUNITY
(to be completed by applicant)
Date Filed: Planning Case No.
1. Developer or Project Sponsor:
Name: Grow Organic 5, Inc
Address: 2837 Lenwood Rd, Barstow. CA 92311
Barstow State: CA Zip: 92311
City:
2. Address of project:
2837 Lenwood Rd, Barstow, CA 92311
3. Assessor's Block and Lot Number : 0428-211-26-0000
4. Primary Project Contact
Raymond Mirzabegian Phone: 818-482-0358
2837 Lenwood Rd, Barstow, CA 92311 [email protected] | State: | CA | Zip: 92311
5. List and describe any other related permits and other public approvals required for this project, including those required by city, regional, state and federal agencies:
Local building and safety permits - State Cannabis Licenses- Department of Fish & Wildlife Lake & Streambed Alteration Agreemen State Water Control Resources Board Water Quality Protection permit
6. Existing zoning district: Commercial
7. Proposed use of site (Project for which this form is filed):
Commercial Cannabis Activity - Dispensary - Cultivation - Manufacturing - Distribution - Non Store Front Delivery - Special Events
PROJECT DESCRIPTION
8. Site size: 1,279,793 sqft / 29.38 Acres
9. Square footage: 330,000 sqft
10. Number of floors of construction:
11. Amount of off-street parking provided and number of employees per shift/total:
Ample Parking on Site
12. (Attach Plans)
13. Anticipated incremental development (ie., phasing):
1 Phase
14. If this is a commercial project, indicate the type of project, whether neighborhood, city or regionally oriented, square footage of sales area, and loading facilities:
This end transert on grin and i l one ain at y it paral and seal roden mara ruined within
15. If this is an industrial project, indicate the type of project, estimated employment per shift, and loading facilities:
None
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 55 of 68
16. If this is an institutional project, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project:
None
17. If the project involves a variance, conditional use permit, or rezoning application, state this and indicate clearly why the application is required:
This project requires a Conditional Use Permit as part of the City of Barstow Cannabis Licenseing process Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary).
YES NO
18. Change in existing features of any hills, or substantial alteration of ground contours.
19. Change in scenic views or vistas from existing residential areas or public lands or roads.
20. Change in pattern, scale or character of general area of project.
21. Significant amounts of solid waste or litter.
22. Change in dust, ash, smoke, fumes or odors in vicinity.
23. Change in lake, stream or ground water quality or quantity, or alteration of existing drainage patterns.
24. Substantial change in existing noise or vibration levels in the vicinity.
25. Site on filled land or on slope of 10 percent or more.
26. Use or disposal of potentially hazardous materials, such as toxic substances, flammables or
27. Substantial change in demand for municipal service (police, fire, water, sewage, etc.).
28. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.).
29. Relationship to a larger project or series of projects.
ENVIRONMENTAL SETTING
30. On a separate page, describe the project site as it exists before the project, including information on topography, soil stability, plants and animals, and any cultural, historical, or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. Snapshots, digital or polaroid photos will be accepted.
31. On a separate page, describe the surrounding properties, including information on plants and animals and any cultural, historical, or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height, frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots, digital or polaroid photos will be accepted.
NOTE: Before the Lead Agency can accept this application as complete, the applicant must consult the lists prepared pursuant to Section 65962.5 of the Government Code and submit a signed statement indicating whether the project and any alternatives are located on a site which is included on any such list, and shall specify any list.
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present data and information required for this initial evaluation to the best of my ability, and that the facts, statements, and in formation presented are true and correct to the best of my knowledge and belief.
Pregnand Miro, abe gars. | 12/6/2022
Signature: Date:
Grow Organic 5, Inc
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 56 of 68
HAZARDOUS WASTE AND SUBSTANCES STATEMENT
The development project and any alternatives proposed in this application are contained on one or more of the lists of hazardous waste sites and facilities compiled pursuant to Section 65962.5 of the Government Code. Accordingly, the project applicant is required to submit a signed statement which contains the following information:
1. Name of applicant: Raymond Mirabegian
2. Address: 2837 Lenwood Rd, Barstow, CA 92311
3. Phone Number: 818-482-0358
4. Address of Site (street name and number if available, and ZIP code):
2837 Lenwood Rd, Barstow, CA 92311
5. Local Agency (city/county): City of Barstow / San Bernardino County
6. Assessor's book, page, and parcel number: 0428-211-26-0000
7. Specify any list pursuant to Section 65962.5 of the Government Code:
8. Regulatory identification number:
9. Date of List:
ParmAnd Miraple sau | 12/6/2022
Signature: Date:
Raymond Mirzabegian
For: (Applicant)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 359E5B4F-D190-4709-A81E-AA072C68E033 REV 1/5/2022 Cannabis License Application Page 53 of 68 Notice of Acknowledgment
As part of the application process, it is understood that the applicant, agent and/or owner may be responsible for the implementation of conditions as well as additional fees and/or processes that may include, but are not limited to the following:
Conditions:
1. Some projects may require the installation of paving, curb, gutter and/or sidewalks;
2. Some projects may require the construction of a trash enclosure per City Standards;
3. Landscaping may be required by Code or as directed by the Planning Commission;
4. Other development requirements to bring the project into conformance with applicable codes and consistency with the surrounding neighborhood.
These potential conditions are dependent upon the scope of the project (i.e., new construction, additions, subdivisions, etc.). Conditions do not take effect until the applicant/agent/owner has agreed and the 5-working day (10 calendar days for subdivisions) appeal period has ended. While the Planning Commission/Hearing Officer has some flexibility in amending the conditions, the intent is to mitigate any potential adverse effects on surrounding properties. In addition, the Planning Commission/Hearing Officer must apply requirements consistently throughout the City.
Additional Fees/Processes:
Projects that cannot be considered as "exempt" from the California Environmental Quality Act (CEQA) may be required to submit a check in the amount of $2,266.25 for negative declarations, or $3,128.25 for environmental impact reports, made payable to the San Bernardino County Clerk of the Board of Supervisors (Clerk) to pay for the State Department of Fish and Game fees as well as a document handling fee from the Clerk. Applications requiring an Environmental Impact Report (EIR) will be subject to additional fees (i.e., consultant fees for development of the EIR).
Projects that cannot be considered as "exempt" from CEA may require the submittal of surveys such as: Biological, Archaeological, Drainage, Geotechnical, etc. prior to processing the applications) for public hearing. The applicant, agent and/or owner should contact the Planning Department prior to project submittal to determine if these surveys are required.
Projects that are exempt or require a Notice of Determination from CEQA may be required to submit a Notice of Determination or Notice of Exemption with the County Clerk of the Board of Supervisors.
Filing fees for either is $50 and shall be made payable to the San Bernardino County Clerk of the Board of Supervisors for document handling.
The fees associated with this/these application(s) are for the Planning Department process only.
Construction/permit fees are separate and are based upon the valuation of the project (for construction, alteration, signs, encroachment permits etc.).
Other unforeseen costs/requirements imposed by the Planning Commission or Hearing Officer.
It is also acknowledged that representation is required at the hearing and that failure to have representation may result in the continuation or potential denial of the application(s). The applicant/agent/owner shall receive notification of the hearing prior to the meeting date for a public hearing item.
Signed:
Parusend Miry, abe grain. 12/6/2022
Applicant/Authorized Agent Date
12/4/2072
Property Owner Authorized Agent Date
* Unless signed by the property owner, the Applicant/Authorized agent is responsible for notifying the owner of these possible conditions, processes and fees prior to the hearing. 220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home