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L. Pee Deferral Schedule if the project's on-site air pollution reductions(mitigation measure)insufficiently reduced air pollution as outlined in Rule 95(0,an off-site fee is assessed based on the excess air pollution. The money collected from this lee will be used by die District to reduce air pollution emissions`ofF-site'on behalf of the project, An Applicant may request a deferral of all or part of the`orf-site'lees up to,but not to exceed,the start date of construction. The start orconsh•uction is any ofthe following,whichever occcurs first:start of grading,start of demolition,m•any other site development activities not mentioned above. ❑ 1 request it Pee Deferral Schedule,and have enclosed the Fee Deferral Schedule Application. The Fee Deferral Schedule Application,can be found on the District's website est www vallevair.org. M. Change of Project Developer The Applicant assumes all responsibility lot-ISR compliance for this project. if the project developer changes,the Applicant must nodry the Buyer,and both Buyer and Applicant must file it'Change of Project Developer'form with the District, if there is a change of project developer,and a'Change of Project Developer'form is not filed with the District,[lie Applicant will remain liable for ISR compliance. NOTED The Change of Project Developer form can be found on the District's website at www,vallegair.org. N. Attachments Regnirerlr !f appiicable'. Tract Nlap or Project Design Map ❑Letter from Applicant granting Agent authorization $�Vicinity Mnp ❑Fee Dclen•al Schedule Application Application Filing Fee ❑ivfonitoring S.Reporting Schedule $84 1,00 for mixed use and non-residential projects OR $562.00 for residential projects only Nlen Supporting documentation For selected Mitigation sures 0. Certification Statement i I certify that L have reviewed and completed the entire application and hereby attest that the inFornnation relayed within is true and correct to the best of my knowledge. l commit to implementation of those on-site mitigation measures that i have selected above. I an responsible for notifying the District it'l will be unable to implement these mitigation measures. Ira committed mitigation measure is not implemented,the project may be re-assessed for air quality impacts. (An authorized Agent may sign the form in lieu of the Applicant Wan authorization letter signed by the Applicant is provided). Name(printed):_ - "Title: C Signature: _ Dale: / ! Central Region Office: 1990 E.Gettysburg Ave,Fresno,CA 93726-02,14 TEL(559)230.6000 FAX(559)230.6061 WEB www.v-a laair.org Page 4 of'12 ResidentialfNon-Residential/Mixed-Use Application Form Revised June 26,2019