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L. Fee Deferral Schedule If the project's on-site air pollution reductions(mitigation measure)insufficiently reduced air pollution as outlined in Rule 9510,an off-site fee is assessed based on the excess air pollution. The money collected from this fee will be used by the 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 `off-site' fees up to,but not to exceed,the start date of construction. The start of construction is any of the following, whichever occcurs first: start of grading, start of demolition,or any other site development activities not mentioned above. ❑ I request a Fee Deferral Schedule,and have enclosed the Fee Deferral Schedule Application. The lee Deferral Schedule ,=application,can be found on the District's website.at www.valleyair.omy. M. Change of Project Developer The Applicant assumes all responsibility for ISR compliance for this project. If the project developer changes,the Applicant must notify the Buyer,and both Buyer and Applicant must file a`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,the Applicant will remain liable for ISR compliance. The Change of Project Developer form can be found on the District's website at www.valleyair.orx. N. Attachments Required: If applicable: Jam` Tract Map or Project Design Map ❑Letter from Applicant granting Agent authorization )0 Vicinity Map ❑Fee Deferral Schedule Application G Ap lication Filing Fee ❑Monitoring&Reporting Schedule $841.00 or mixed use and non-residential projects OR ❑ Supporting documentation for selected Mitigation Measures $562.00 for residential projects only O. Certification Statement I certify that I have reviewed and completed the entire application and hereby attest that the information relayed within is true and correct to the best of my knowledge. I commit to implementation of those on-site mitigation measures that I have selected above. I am responsible for notifying the District if I will be unable to implement these mitigation measures. If a 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 if an authorization letter signed by the Applicant is provided). Name(printed): tj ' .> ,'s ..fr. 4 t.sf. Title: Signature: t `` Date: t t Central Region Office: 1990 E.Gettysburg Ave. Fresno,CA 93726-0244 TEL(559)230-6000 FAX(559)230-6061 WEB www.valleyair.orq Page 4 of 12 Reside ntiaI/Non-Residential/Mixed-Use Application Form Revised June 28,2019