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S9AN . JOAQUIN 3COMMUNITY DEVELOPMENT DEPARTMENT
<br /> 0 7�J i\l I Y ADM INISTRATIVEICONDITIONAL USE PERMIT
<br /> r ,_ r , I : � : , : FiLE NUMBER ,
<br /> / LEVINE ACT
<br /> Effective January 1 , 2023 , California Political Reform Act of 1974, Government Code § 84308, known I have read and understand
<br /> as the Levine Act , prohibits any San Joaquin County Board of Supervisor member from participating In that this application is
<br /> any agenda item involving a discretionary land use permit or other entitlements If the Board member subject tot provisions :
<br /> has received any political contributions from the owner, applicant, or agent for the owner or applicant
<br /> totaling more than $ 250 in the 12 months before the decision (but not before January 1 , 2023) and for
<br /> the 12 months following the decision . The Act also prohibits an owner , applicant, or agent for the owner Initial
<br /> or applicant from making a contribution of more than $250 to a member of the Board of Supervisors /r , � ��
<br /> while the item is pending and for the 12 months following the date a final decision Is rendered .
<br /> Date
<br /> AUTHORIZATION SIGNATURES
<br /> ONLY THE OWNER OF THE PROPERTY 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 harmless the County
<br /> and its officers , officials , 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
<br /> liabilities arising out of, related to, 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 applied for project by the County, the adoption of environmental review documents related to 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 expenses incurred by the County on account of any Claim , except where such indemnification is
<br /> prohibited by law, Including but not limited to damages, costs , expenses , attorney's fees , or expert witness costs that may be asserted
<br /> by any person or entity , private attorney general fees claimed by or awarded to any parry against the County, and the County's costs
<br /> Incurred in preparing an administrative record which are not paid by the petitioner.
<br /> C . Except as to the County 's sole negligence or willful misconduct .
<br /> 2 . DEFENSj ;
<br /> A . The County may participate or direct the defense of any Claim . The County 's actions in defense of any claim shall not
<br /> 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 have the
<br /> authority to control the litigation and make litigation decisions , Including , but not limited to , the manner in which the defense is
<br /> conducted .
<br /> C . if the County reasonably determines that having common counsel presents such counsel with a conflict of interest , or If
<br /> fall to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County , then County may
<br /> utilize the Office of the County Counsel or employ separate outside counsel to represent or defend the County , and i shall pay the
<br /> 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 application , or,
<br /> ❑ Legal agent ( attach proof of the owner's consent to the application of the properties Involv.W In this application ) and have been
<br /> authorized to file on their behalf, and that the foregoing application statements are true correct .
<br /> Print Name : e-.'
<br /> Signature : _ Date : milli
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<br /> Print Name , Signature : Date :
<br /> Print Namc : Signature : Date :
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