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SAN 1AQ�11 �1 COMMUNITY DEVELOPMENT DEPARTMENT
<br /> COUNTY MOUNTAIN HOUSE
<br /> Greatness grows here. USE PERMIT, SITE APPROVAL &
<br /> IMPROVEMENT PLAN APPLICATION
<br /> FILE NUMBER:
<br /> AUTHORIZATION :SIGNATURES `
<br /> ONLY'TkE OWNER OF THE iPROPERTY.OR AN AUTHORIZED AGENT MAY FILE'AN APPLICATION
<br /> I,the Owner/Applicant/Agent agrees to Indemnify, defend (with counsel reasonably approved by County),and hold
<br /> harmless the County and its officers,officials,employees,agents, boards and commissions(collectively"County")as
<br /> follows:
<br /> 1. INDEMNITY:
<br /> A. From and against any and all claims,demands,actions, proceedings,lawsuits, losses,damages,
<br /> judgments and/or liabilities arising out of, related to, or in connection with the application and applied for project or to
<br /> attack, set aside,void, or annul, In whole or in part, an approval of the applied for project by the County,the adoption of
<br /> environmental review documents related to the applied for project,and any related development approvals or project
<br /> conditions for 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
<br /> indemnification is prohibited by law,including but not limited to damages,costs, expenses,attorney's fees,or expert
<br /> witness costs that may be asserted by any person or entity, private attorney general fees claimed by or awarded to any
<br /> party against the County,and the County's costs incurred in preparing an administrative record which are not paid by the
<br /> petitloner.
<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
<br /> claim shall not relieve me of any obligation to 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
<br /> have the authority to control the litigation and make litigation decisions, including,but not limited to,the manner in which
<br /> the defense is conducted.
<br /> C. If the County reasonably determines that having common counsel presents such counsel with a conflict of
<br /> interest,or if I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to
<br /> the County,then County may utilize the Office of the County Counsel or employ separate outside counsel to represent or
<br /> defend the County,and I shall pay the reasonable attorneys'fees and costs of such counsel.
<br /> I,further,certify under penalty of perjury that I am(check one):
<br /> 'Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s)involved in this
<br /> application, or
<br /> ❑ Legal agent(attach proof of the owner's consent to the application of the properties involved in this application)and
<br /> have been authorized to file on their behalf, and that the foregoing application statements are true and correct.
<br /> Print Name: T 1� KA I L'
<br /> Signature:
<br /> , �r4G i Date: 1 off.
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: _ _ Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Page 7 of 7
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