Fillable Revision Application REV: November 5, 2020 (City of El Monte)

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Revision Application REV: November 5, 2020 (City of El Monte)

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CITY OF EL MONTE
DEPARTMENT USE ONLY
APPLICATION # _________________
SUBMITTAL DATE
__________________________
Commercial Cannabis Business License
11333 Valley Blvd.
El Monte, CA 91731
Phone: (626) 258-8626
cannabis@elmonteca.gov
The Friendly City of El Monte
City
State
Zip Code
Area Code/Telephone
Sole Proprietor
Partnership
Corporation
L.L.P.
L.L.C.
Business E-Mail
Fed Tax ID No.
State ID No.
Does your business have a California State License?
Yes
No
State License Number
Classification(s)
Address
E-Mail
Telephone
Address
Area Code/Telephone
Driver's License No.
State
Expiration Date
Social Security No.
Home Address
Area Code/Telephone
Driver's License No.
State
Expiration Date
Social Security No.
Revision Application
REV: November 5, 2020
ly City of El Monte
e Friendly City of El Monte
Monte
11333 Valley Blvd.
El Monte, CA 91731
Phone: (626) 258-8626
cannabis@elmonteca.gov
The Friendly City of El Monte
Local Cannabis Application/License # ___________________________
DATE
APPLICANT SIGNATURE
BUSINESS OPERATIONS INFORMATION
PROPERTY INFORMATION
1. Specify the type of revision requested (Mark ALL that apply)
Location Ownership Minor Info
2.
Zoning Designation
General Plan Designation
Assessor Parcel Number(s)
3.
Has the applicant obtained a Letter of Zoning Compliance? ATTACH COPY
YES NO
NARRATIVE
Please describe, in as much detail as possible, your proposed changes
1 2
: (Attach additional sheets if necessary)
ACKNOWLEDGEMENT
I hereby certify that I am the applicant, licensee or designated agent named herein and that I am familiar with the rules and regulations with respect to preparing and filing this Commercial
Cannabis Business License Revision Application, and that the statements and answers contained herein and the information attached are in all respects true and accurate to the best of
my knowledge and belief.
In addition, I understand that the filing of this application grants the City of El Monte permission to reproduce submitted materials, including but not limited to: plans, exhibits, and
photographs for distribution to staff, Commission, Board, and City Council members, and other Agencies in order to process the application. Nothing in this consent however, shall entitle
any person to make use of intellectual property and confidential personal information in plans, exhibits and photographs for any purpose unrelated to the City's consideration of this
application.
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The property owner further certifies that they are the legal owner of the property, consent to the filing of this application and have authorized the applicant below to represent them with
respect to the processing of this application.
PRINT NAME/TITLE
PROPERTY OWNER SIGNATURE
DATE
PRINT NAME/TITLE
CITY OF EL MONTE
Commercial Cannabis Business License
Revision Application
IF APPLICABLE
1
For changes in premises, location, and/or layout information please submit: revised site plan, floor plans, elevations, premises diagram, security plan, and a revised sensitive
radius map, if applicable. Applicant/licensee must also receive approval from LA County Fire Department and LA County Public Health Department
2
For majority changes in ownership information, please submit color copies of valid government issued photo identification, proof of current address, and submit for background
checks with HdL Companies at: https://hdlcompanies.formstack.com/forms/bc_el_monte ; submit revised articles of incorporation, if applicable.
Expansion
Major Info
click to sign
signature
click to edit
APPLICANT CERTIFICATION
I hereby certify, under penalty of perjury, on behalf of myself and all owners, managers and supervisors identified
in this application that the statements and information furnished in this application and in the attached exhibits
present the data and information required for this initial evaluation to the best of my ability, and that the facts,
statements, and information presented are true and correct to the best of my knowledge and belief. I understand
that a misrepresentation of fact is cause for rejection of this application, denial of the permit, or revocation of a
permit issued.
In addition, I understand that the filing of this application grants the City of El Monte permission to reproduce
submitted materials, including but not limited to, plans, exhibits, and photographs, for distribution to staff,
consultants, and other Agencies in order to process the application. Nothing in this consent, however, shall
entitle any person to make use of the intellectual property in plans, exhibits and photographs for any purpose
unrelated to the City's consideration of this application.
Furthermore, by submitting this application I understand and agree that any business resulting from an approval
shall be maintained and operated in accordance with requirements of the El Monte Municipal Code and State law.
Name
Signature
Title
Date
A notary public or other officer completing this certificate verifies only the identity of the individual who
sig
ned the document to which this certificate is attached, and not the truthfulness, accuracy, or validity
of that document.
State of California
County of
Subscribed and sworn to (or affirmed) before me on this __________ day of ______________, 20___, by
____________________________________ , proved to me on the basis of satisfactory evidence to be
the person(s) who appeared before me.
(Seal) Signature
PROPERTY OWNER CONSENT
If applicant is other than the property owner(s), the owner(s) must provide a signed statement consenting to
filing pursuant to Ordinance No. 2960 of the El Monte Municipal Code. Original signatures only.
I/We, as the owner(s) of the subject property, consent to the filing of this application and use of the property for
the purposes described herein. We further consent and hereby authorize City representative(s) to enter upon my
property for the purpose of examining and inspecting the property in preparation of any reports and/or required
environmental review for the processing of the application(s) being filed.
Name
Signature
Title
Date
A notary public or other officer completing this certificate verifies only the identity of the individual who
sig
ned the document to which this certificate is attached, and not the truthfulness, accuracy, or validity
of that document.
State of California
County of
Subscribed and sworn to (or affirmed) before me on this __________ day of ______________, 20___, by
____________________________________ , proved to me on the basis of satisfactory evidence to be
the person(s) who appeared before me.
(Seal) Signature
(Required for changes in location or expansion ONLY)
# of License
Uses
License
Transfer
Location
Change
Minor
Change
in Info
Major
Change
in Info
City
Manager
Appeal
One 6,956.01$ 8,322.56$ 1,353.18$ 8,759.62$ 5,894.52$
Two
13,912.02$
16,645.13$ 2,706.35$ 17,519.24$ 11,789.03$
Three 20,868.03$ 24,967.69$ 4,059.53$ 26,278.85$ 17,683.55$
Four
27,824.04$
33,290.26$ 5,412.70$ 35,038.47$ 23,578.06$
COMMERCIAL CANNABIS BUSINESS LICNESE REVISION APP - ASSOCIATED FEES
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Revision Application REV: November 5, 2020 (City of El Monte)

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Completed 21 January 2021

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