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SAN _J OAQ U I N COMMUNITY DEVELOPMENT DEPARTMENT
<br /> � BUSINESS LICENSE
<br /> :r -COUNTY
<br /> FILE NUMBER: �L" Zvc�y� �1
<br /> `'t.rrca?'P Greatness grows here. Rgsp seD Date:
<br /> FOR STAFF USE ONLY 4 (5
<br /> Business Information Applicant Information
<br /> Business(DBA)Name: Cp!'I_�7✓ �� NW Name: kLov,,n
<br /> Mailing Address: j 4414y /\/_ 4W C/cl �- Mailing Address: ( S9,qhway Y 43,jagS A)df.
<br /> Phone_La p� 1_33�r_ v?�5- -- ------------._.. Phone: �--
<br /> Email: J2en(i, ru et c�on4inenhc/S•vp /y t7W, Cc Email: NjSU S e SCCOcfne-
<br /> Property Information
<br /> Assessor Parcel Number Property Address City Cross Street
<br /> 1
<br /> O —�f3 - t i9�i Iv. 1 fw C1.9A cam ,� -- --- --.- - ---
<br /> �1brfd , e,
<br /> Business Details
<br /> Description of Business:
<br /> i
<br /> ---- —._._..__..._._
<br /> Type of Organization: ❑Single Owner ❑ Partnership El Corporation Other:
<br /> _._._.........
<br /> _ _
<br /> Does the business include the sale of firearms? ❑Yes No
<br /> Number of Employees Hours of Operation Water Service Sewer Service
<br /> Full Time Part Time Public Private on-site Public Private on-site
<br /> ---- ---- --- '7a m m (on-site) ( )
<br /> ry F ❑ ❑
<br /> NOTE:ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> AUTHORIZATION SIGNATURES
<br /> I,the Owner/Applicant/Agent,agrees to indemnify,defend(with counsel reasonably approved by County),and hold harmless the County and its officers,officials,
<br /> employees,agents,boards and commissions(collectively"County")as follows:
<br /> 1. INDEMNITY:
<br /> A.From and against any and all claims,demands,actions,proceedings,lawsuits,losses,damages,judgments and/or liabilities arising out of,related to,or in
<br /> connection with the application and applied for project or to attack,set aside,void,or annul,in whole or in part,an approval of the applied for project by the
<br /> County,the adoption of environmental review documents related to the applied for project,and any related development approvals or project conditions for
<br /> the applied for project(hereinafter"Claim");
<br /> B.For any and all costs and expenses incurred by the County on account of any Claim,except where such indemnification is prohibited by law,including but
<br /> not limited to damages,costs,expenses,attorney's fees,or expert witness costs that may be asserted by any person or entity,private attorney general fees
<br /> claimed by or awarded to any party against the County,and the County's costs incurred in preparing an administrative record which are not paid by the
<br /> petitioner.
<br /> C.Except as to the County's sole negligence or willful misconduct.
<br /> 2. DEFENSE:
<br /> A.The County may participate or direct the defense of any Claim.The County's actions in defense of any claim shall not relieve me of any obligation to
<br /> indemnify,defend,and hold harmless the County.
<br /> B.In the event of a disagreement between County and me regarding defense of any Claim,the County shall have the authority to control the litigation and
<br /> make litigation decisions,including,but not limited to,the manner in which the defense is conducted.
<br /> C.If I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County,then County may utilize the Office
<br /> of the County Counsel or employ separate outside counsel to represent or defend the County,and I shall pay the reasonable attorneys'fees and costs of
<br /> such counsel.
<br /> I,the Owner/A lican A ent ffirm all the information above is true and correct,under penalty of pejury.
<br /> Print Name: f- /YJe' Z,;Signature: Date: 3- 3i-3U u
<br /> FOR STAFF USE ONLY
<br /> General Plan Designation:/1- Zoning Designation: "-I- Use Type:
<br /> Department Approv Denied ignature Date
<br /> CDD:Planning Division
<br /> Building Division
<br /> Enforcement Division
<br /> Fire District/Warde
<br /> Environmental Health Department
<br /> Department of Public Works
<br /> MHCSD(if applicable)
<br /> License approved for: Pn �� • �� ���t,�1�1'`� ��\��,� �.0 —
<br /> History:
<br /> L-� 2�
<br /> Finalized by: Date
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