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SAN lOAQUIN COMMUNITY DEVELOPMENT DEPARTMENT
<br /> JL BUSINESS LICENSE
<br /> -----COUNTY- — FILE NUMBER:
<br /> FOR STAFF USE ONLY
<br /> Business Information Applicant Information
<br /> Business(DBA)Name:LA FAVORITA Name:Karina Coma-Valdez
<br /> Mailing Address:8125 S EL DORADO ST Mailing Address:8125 S EL DORADO ST
<br /> French Camp,CA 95231 French Camp.CA 95231
<br /> Phone:(209)982-0897 _Phone:(209)401-3348_ _
<br /> Email:jandlevk63@gmall.com Email:karinaasmiieel2l@icloud.com
<br /> Property Information
<br /> Assessor Parcel Number Property Address City Cross Street
<br /> 193-170-03 8125 S EL DORADO ST I French Camp,CA 95231 W MATHEWS RD
<br /> Business Details
<br /> Description of Business:Deli and Service Station
<br /> Type of Organization: ❑Single Oer_ PeltneBhip
<br /> wn ❑ N Corporation ❑Other.
<br /> Does the business include the sale of firearms? ❑Yes ❑e No
<br /> Number of Employees Hours of Operation Water Service Sewer Service
<br /> Full Time Part Time Public Private(on-site) Public Private(onsite)
<br /> 10 Daily, 5 a.m. to 10 p.m. O 1 ❑ 1 p ❑
<br /> NOTE:ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> AUTHORIZATION SIGNATURES
<br /> I,the OwnerlApplimnUAgent 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(mllectively'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 par,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'Clalm'):
<br /> B.For any and all costs and expenses Incurred by the County on accountof any Claim,except where such indemnification Is prohibited by law,including but
<br /> not limited to damages,costs,expenses,attomeys fees,or expert witness costs that may be asserted by any person or entity,private attorney general lees
<br /> claimed by or awarded to any party against the County,and the County's costs incurred In preparing an adm ndstrative record which ere 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 Comfy'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 airy Claim,the County shall have the authority to control bre litigation and
<br /> make litigation decisions,Including,but not limited to,the manner in which the defense Is conducted.
<br /> C.If 1 fall to promptly assume the defense of any Claim or to promptly employ counsel reasorrably 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 1 shall pay the reasonable aaomays'fees and costs of
<br /> such counsel.
<br /> I,the OwneN licant/A ent,affirm all the information above is true and m t ntle 1 e
<br /> Print Name: Kenna Cema-Valtlez Signature: 1, Date:
<br /> FOR[JF S T(ONLY
<br /> Us,
<br /> l > nGeneral Plan Designagomi 5n
<br /> Department
<br /> Approved Denied Signature Do"
<br /> CDD:Planning Division // 5.; T 7,7777 _. 5 �l3� C
<br /> Building DIAslon
<br /> Enforcement Division
<br /> Fire DlsblctVv
<br /> Environmental Health Department 8yf y.� U ( �j•.")I';to]Department of Pubic Works
<br /> MHCSD(H applicable)
<br /> License approved for: /J�+� `13 Sf•t 4, .•-, M•h.' �v�c C-+/ �: y. ,:,^� l/nr . >
<br /> JJL
<br /> History: /3 (i` <J•� ZZ.i -)
<br /> Finalized by: Date
<br />
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