HARDSHIP EXEMPTION APPLICATION

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ICO Area: Council File No.:

Effective Date:

Applicant (Record Owner): MAiffit:W O~l'ti\l Telephone:

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Applicant Mailing Address Zip Code:
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Applicant's Representative Telephone:

Representative's Mailing Address: Zip Code:

Lot Area (sq. ft.):

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Note: A Master Land Use Application is not required.

OCT 0 7 2008
Page 3 of5
PLANNING & LAND
USE MANAGEMENT
 Describe Proposed Project and Use (Include size in square feet, height, etc.):

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Why do you believe a hardship exists for which an exemption should be granted? (Attach a statement on
a separate sheet if necessary. An economic analysis may also be submitted.)
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Do you have any ownership interest in any other parcels within 300 feet of this property? ( )Yes ( ) No
(If yes, submit a map showing the location and boundaries of the property for which an exemption is being
requested, and the location of the other ownerships.)

ADDITIONAL INFORMATION FILING REQUIREMENTS

In addition to this form, all below items should be included with the application, unless otherwise instructed by City
Staff.

a. Attach a map showing the location and boundaries of the property for which the exemption is being
requested. (May be the same map as required in No.7)

b. Attach a Plot Plan showing the building footprint, parking plan, landscaping, balconies, driveways,
any amenities, etc.

c. Attach an Elevation Plan, which includes dimensions for all views.

d. Attach Building Plans. If plans have been accepted by the Department of Building and Safety, list Plan
Check No. and Submittal Date _

e. Submit a Project History summary that includes dates and descriptions of meetings, negotiations,
expenditures, commitments, etc.

f. Submit Photographs of the subject property and all surrounding property - not over 8 Y, x 11 inches, but of
adequate size to illustrate the condition and physical context of the property under discussion.

g. Attach any additional information as needed.

Note: A Master Land Use Application is not required.

Page 4 of5
 M"'TlrlN IS TRUE AND CORRECT TO THE ES OF MY KNOWLEDGE.

Date

Representative Date

* Proof of ownership will be required at the time of application submittal. A recorded grant deed and/or
City Clerk's ownership records printout are acceptable.

Note: A Master Land Use Application is not required.

Page 50f5
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Why a hardship exists for which an exemption should be granted:

Advanced Patient's Collective (APC) qualifies for an exemption because it

meets the requirements for a hardship exemption. APC's business license
dates back to 2005 and APC successfully filed for the pre-moratorium
permit in September of2007(attached). APC is being forced to move by
means of pressure placed upon its current landlord in the form of the DEA's
unscrupulous threat letter. We are relocating just several blocks from our
prior location, the same area we have always been with no other licensed
collective existing in the same immediate area. We strongly prohibit any
redistribution of medicine and enforce a policy of permanent loss of access
to any patient observed doing so. We strictly enforce all patient
documentation requirements and regularly verify all patient documentation.

Advanced Patient's Collective has always been a tax paying, guideline

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!I • following collective. Working with Dr. Michael Engleberg of Cedar Sinai's

Cancer Center we have been taking care of patients of all status: Veteran,
SSI, SDI, low income and terminal illness. We work with Los Angeles
Police Department Senior Lead Officer Danny Pesqueria to make sure our
facility and patient care methods are safe and secure and criminal free. We
follow all the guidelines of the California health and safety code section
11362.5(b) (1) (a) and 11362.7(h) as well as the guidelines recently issued
by the state attorney general. These are the qualifying reasons for a hardship
exemption as dictated by the city ordinance pertaining to our business.

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, . MEDICAL MARIJUANA DISPENSARY
BUSINESS INFORMATION FORM

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Telephone Number
(373) LjbY-6Lj6S
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Street Address, Unit # I
(500 60WD?- ST, I

City, State, Zip ------ --------~I,

L-D~ tv0~S I etA Uloen-S"16425
Business Owner
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Fill out the information form above and attach the following documents.

~a. City of Los Angeles Tax Registration Certificate

ifb State Board of Equalization seller's permit

~~ Property lease or documentation of ownership 2007 SUo I 9 r;. 2: C 3

~. Business insurance

¥e. Dispensary membership forms (blank)

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• o f. Los A geles County Health Department permit (if needed)

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I certify that to the best of my knowledge and under the penalty of perjury, that the information
contained on this Medical Marijuana Dispensary Business Information Form is correct.

I further certify that to the best of my knowledge and under the penalty of perjury, that attached
documents are correct and true.