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12/0/2021 13:14 Canepa a Sons
<br />(FAX)
<br />Srm ADoRnss: .� 3 S, ! o�!/� ,J SJf' PERMIT#t
<br />P, 004/007
<br />' ' 4 t -' v
<br />I, the Owner/Appllcarvl/Uo nspd Well OrillettPump Contras agrees to Indemnify, defend with counsel reasoRabty spVv ed by Coont�, and hold hermis%
<br />1.
<br />g. From and against ahy and 0 dolma, demands, actions, ptvcssd;ngs, lawsuits] losses, damages, judgments and/or IlabMes wising out
<br />qf, related to, or to oonnedlon wfth the appfication and applied for well or pump orto attack, act aside, void, or aonilt, In whole or In pare
<br />approval or dental of the applied for perrgtt by the County, and any emdronnmet�ai Wow dot uments related to the applied for palmtt
<br />b. Por any and 4 costs and wzper4sa incurtrd by the County on account of any im, Mept where stxdt indemrttfie�ort is prohibited by
<br />law, including but not limited to damages, costa, expenses, atturneya flea, or witness costs that 11rdy be asserted by arty person
<br />or entity, private attomaygeneral fess claimed by or awarded to arty party agaln*tthe County, and the County's 00sts hmirred in prepaft
<br />an adrnive record which are not paid by the petitioner.
<br />C.
<br />Fxccpt as to tha Countys sole negligence orwVvI m4Wndutt, I .
<br />L Defense:
<br />a, The County may parddpats or direct thoidefense of ony Claim, The Countys action In defense of any claim shop retiave me of v�Y
<br />oblfgation to indemnify, defend, And hold harmless the County.
<br />b, in the event of a d'reegrwxrent botweentCounty and me regarding defense ofiany Claim, the County shall have the authority to control
<br />the lirigadon and make Agadon dt:islon�, Including, but not itmited to, the manner in which the defense is wndu�
<br />If County reasonably determines that having common eounsal prevents such eounsei with a ooetR t -of interest. or if I fat to promptly assume the defense of
<br />any Claim or to prompNy employ counsel reasombly sorry to the Counter, then Couribj tnay the Office of the Cormty Court, or employ *operate
<br />outside counsel to represerjt or defend the County, and I shay tray the r=onable atfemeys' fees d � cf ouch cetrruel.
<br />I HEREBY CEr{i1PY THAT I HAVE PwAREo THIS APPLATION AN4 'NAT THE! WORK , LL ae CONE: IN ACCORDANCE SAN JOAQUIN
<br />COUNTY ORDINANCES, STATE LAWS, AND RULES Afro REGULATIONS. I ALSO CERTIF,`/ THAT MY REOUIRED LICENSE t3 CURRENT AND
<br />ACM15 WITH THE CAUFORNIA CONTRACTORS STIATE LICENSE BOARD AND THAT I Aid IN COMPLIMM ALL WORKERS
<br />COMPENSA N LAWS,
<br />PROPERTY K: l
<br />SIGN,k'rs�� r ..... >4J l PRiNr. G DAT,
<br />SIGHIStem;
<br />rs=v tau tr cotmucrea PRirrt': 2A .F / y 3j9 2—
<br />(�¢ � � _ — UA,re fir. i
<br />, I
<br />A=ONION FOR OT M THAN C-57 SIGNING PERMIT APPUCATION
<br />" pr�orant+�eaNcm >») harobyauthotixe,t�or�seee�aAs+W l
<br />to sign this gau YcaquinlConnty W6t' & Bating Permit Application on my behaMf I uan d this utb tmton is vd I for one year end
<br />is limited to the Work plaz dated oa the Avat pago of#s znUca i=
<br />t. l
<br />EHO 4348
<br />11(23!21
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