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i1 ('ANnI I I COMMUNITY DEVELOPMENT DEPARTMENT
<br /> S
<br /> .''JOAQUIN BUSINESS LICENSE
<br /> —COUNTY—
<br /> FILE NUMBER: C-Z2ootor)
<br /> Greatness grovrs here.
<br /> se�7u�ate•
<br /> FOR STAFF USE ONLY f "1//J _�-
<br /> Business Information Applicant Information �/
<br /> Business(DBA)Name: LA (L�Ck1A.l Name: EPrIZA,�
<br /> Mailing Address: Mailing Address: C Q
<br /> CA X31 to Sal b
<br /> Phone: _ -�-. - (,- G Phone: - '116-15010
<br /> Email: Email: - f78 (, O 0. x
<br /> Property Information -
<br /> Assessor Parcel Number Property Address I City Cross Street
<br /> IL50- i - 0A 19,16 W. lit q I nAq I r-HpImW RD ,
<br /> Business Details
<br /> Description of Business Ifyop 'TClaxfE NO ot >f t uoO{L
<br /> Type of Organization: Single Owner ❑Partnership ❑Corporation ❑Other.
<br /> Does the business include the sale of firearms? ❑Yes K 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 /> NOTE:ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> AUTHORIZATION SIGNATURES
<br /> I,the Owner/ApplicantfAgent,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 attach,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(heminafter'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 eVert 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/Applicant/Agent still all the informaton above is true and correct,under 20alty of perjury.
<br /> Print Name: MKIA HQW46040 Signature: Date: 2Z
<br /> FOR STAFF USEJONLY
<br /> General Plan Designation: Zoning Designation: G Use Type: ,f,H 3'><4h t, ' ��:N,.e•+e.,o
<br /> Department Approved Denied Sig ure Date
<br /> CDD:Planning Division _F ' />/L-__ _ __ _S -ZJ1
<br /> Building Division
<br /> Enforcement Divis
<br /> Fre DistrictWard _
<br /> Environmental Health DepadAnt /c _ S00014877—— 9/14/2022_
<br /> Department of Public Works _
<br /> MHCSD(t applicable)
<br /> Ucense approved for: oo 1;,, c 7�s''t a./ i)O 0 SAA' ern
<br /> History: L- 19 to rS t I L-1 5 l( % ., 13c - oqll
<br /> Finalized by: I Date
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