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- SAN..JOApUfN
<br />-__ c o u Iv r Y -..--
<br />COMMUNITY DEVELOPMENT DEPARTMENT
<br />ADMINISTRATIVE/CONDITIONAL USE PERMIT
<br />FILE NUMBER:
<br />'LEVINE'ACT
<br />Effective January 1, 2023, California Political Reform Act of 1 Wq, Gov ent Cotl¢ §84308, known
<br />I have read and unders[a ntl
<br />s the Levine Act, prohibits any San Joaquin County Board of Supervisor member from participating in
<br />that this is
<br />any agenda item involvin8 a discretionary land use permit or other entitlements if fhe Board member
<br />ppsplication
<br />subjact�h a provisions:
<br />has received any political contdbutiona from the owner, applicant, or agent for the owner or applicant
<br />totaling more than $250 In the 12 months bafo ra tM1a daciaion (but not before January 1, 2023) and for
<br />``i
<br />q Initial
<br />'R
<br />ii' Z
<br />the 12 months following the decision. The Act also prohibits an owner, applicant, or agent for the owner
<br />or applicant from making a contribution of mora than $250 to a member of the Board of Supervisors
<br />i� �
<br />while the item is pending and for the 12 months following the data a final decision is rendered.
<br />Date
<br />PaJ.THORIZATION=SIGNATURES
<br />ONLY THE OWNER OF THE PR OPERTY'OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION
<br />I, the Owner/ApplicanUAgent agrees to indemnify, defend (with counsel r nably approved by County), antl holtl harmless the County
<br />and its officers, officials, employees, agents, boards and commissions (collectively "County") asfollows:
<br />1. INDEMNITY:
<br />A. From antl against any and all claims, demands, actions, proceedings, lawsuits; losses, damages, judgments and/or
<br />liabilities arising out of, related So, or In connection with the application and applied for project or to attack, set aside, void, or annul, in
<br />whole or in part, an approval of the appliatl for project by the County, the adoption of environmental r w documents ralatadta the
<br />applied for project, and any related development approvals or project conditions for the applied for project (hereinafter"Claim");
<br />B. For any and all costs and expanses in red by the County on account of any claim, except where. such Intlemniicetlon is
<br />prohibit¢d by law, inclutling but not limited to damages,rcosts, expenses, eKomey's fees, o expert witness costsdhat may ba asserted
<br />by any person or enLty, private attorney general fees claimatl by or awarded to any party against the County, and the CounTy's costs
<br />incurred in preparing an atlministrative recortl which are not paid by the petitioner.
<br />C. Except as to the County's sola negligence or willful misconduct.
<br />2. DEFENSE:
<br />A. Tka County may participate or direct the. tlefense of any Claim. The Eounty's actions Ih defense. of any claim shall not
<br />relieve me of any obligation to intlemnify, defentl, and hold harmless the County:
<br />B. In the avant of a disagreement between County antl me regarding defense of any Claim, the County shall have the
<br />authority to control the litigation antl make litigation decisions, including, but not limited to, the manner in whictrthe defense is
<br />cons uctetl.
<br />C. If She County reasonably determines Shat M1aving common c sal. presents such counsel with a confllcT of Interest, or if 1
<br />fail to promptly assume the defense. of any Clalmor to promptly employ counsel reasonably satisfactory to the Counky, than County may
<br />utilize the Office of the County Counsel or employ separate outside Counsel to represent or defend the County, end 1 shall pay the
<br />reasonable attorneys' fees antl costs oT such counsel.
<br />I, further, certify under penalty of perjury that I am (check one):
<br />CJ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the proparty(s) involved in this application, or
<br />��Legal agent (attach proof oT the owner's consent to the application of the properties involved in this application) and have been
<br />authorized to fila on their behalf, and that the foregoing application statements era true end correct.
<br />1(�i�v �s..in.�.� si tare: /a -off 97�-3
<br />Print Name: gna �— Date:
<br />Print Neme: Signature: Date:
<br />Print Nama: Signature: Date:
<br />Print Nama: Signature: pate:
<br />Print Nama: Signature: Dale:
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