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Y V COMMUNITY DEVELOPMENT DEPARTMENT
<br /> Q aZ'• ,C hSINESS LICENSE
<br /> 6; i! J—COUNTY— AUG 26 2,L, FILE NUMBER: t-
<br /> rows here.
<br /> Greatness
<br /> S Response Due Date:
<br /> L\11Rr1\ \It \ i \1 III. J91iSTAFFUSE ONLY 1 Aq/(.(/,,,Z
<br /> Business Information 1,1- � Applicant Information
<br /> Business(DBA)Name: CE'21, C S Name: N (D
<br /> Mailing Address: p Z w Mailing Address:2 p " w
<br /> Ko`�q W tk o -A gvyqyowl a4rilrw
<br /> Phone: 510 '('f11 ss Nom(ee+okrtPhone: q q 9
<br /> --t/rifrda—
<br /> Email _ tom Email: rvl OU[✓\CAA-.do. (nm
<br /> Property Information
<br /> Assessor Parcel Number Property Address I City Cross Street
<br /> '0�5 35'LOU Chris ✓c`c W• 34-6ril LN
<br /> Business Details
<br /> Description of Business: C �
<br /> Type of Organization: Single Owner ❑Partnership ❑Corporation O'bther. LL_L
<br /> Does the business include the sale of firearms? ❑Yes 2<0
<br /> -
<br /> Number of Employees Hours of Operation Water Service Sewer Service
<br /> Full Time_ Part Time pw Public Private(ote) Public Private(on- 'te)
<br /> fl E C7
<br /> NOTE:ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> AUTHORIZATION SIGNATURES
<br /> I,the Owner/Applicant/Agent,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 Balms,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 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(hereinafer'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 expert 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 Countys sole negligence or willful misconduct.
<br /> 2.DEFENSE:
<br /> A.The County may participate or direct the defense of any Claim.The Countys actions in defense of any claim shall not relieve me of any obligation to
<br /> Indemnify,defend,and hold harmless the County.
<br /> S.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 Ovmer/A Ocentl a I,affirm all the Information above is true and correct,u r e tt of penury.
<br /> Print Name: sn rl r. IrttiOLPY1CrJ Signature: t Date: Q 23 2Z
<br /> FOR STAFF USE ONLY
<br /> General Plan Designation: Zoning Designation: Y4/-l- use Type: ( k rw
<br /> Department Approved Dented r Si nature ptite
<br /> CDD:Planning Division _ 1rq D3 6-
<br /> Building Division
<br /> Enforcement Division
<br /> Fire DistricttWarden: � I_ Q
<br /> Environmental Health Department _ S U 00151 3 yr 5.1J• g o Zoaa
<br /> Department of Public Works
<br /> MHCSD(If applicable)
<br /> License approved for.
<br /> History. S
<br /> Finalized by: .• e Date
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