County of Santa Clara Santa Clara County -Clerk-Recorder Office

County of Santa Clara

Office of the County Clcrk~Recorder Business Division

County Government Center 70 West Hedding Street, E. Wing, 151 Floor San Jose, C:ilifornia 95110 (408) 299-5688

CEQA DOCUMENT DECLARATION

ENVIRQNMENTAL FILING FEE RECElPI

Santa Clara County - Clerk-Recorder Office State of California

File Number: ENV22216

ENVIRONMENTAL FILING No. of Pages: 4 Total Fees: $0.00 File Date: 05/31/2019 Expires?. 07/30/2019

REGINA ALCOMENDRAS, Clerk-Recorder By: Nina KhamphiJath, Deputy Clerk-Recorder

PLEASE COMPLETE THE FOLLOWfNG: 1. LEAD AGENCY: Cit of Palo Alto

2. PROJECT TITLE: Newell Road Bridge Replacement Project 3, APPLICANT NAME: ~M~ic~h~e~IJ~e~r~em=ia~s_ _ _ _ _ _ _ _ _ _ _ _ _ __

PHONE: 650-329-2129

4. APPLICANT ADDRESS: 250 Hamllton Avenue, 5th Floor, Palo Alto CA 94301

5, PROJECT APPLICANT IS A: !BJ Local Public Agency Cl School District D other Speeial District Cl Stale Agency D Private Entity

6. NOTICE TO BE POSTED FOR

60

DAYS,

7. CLASSIFICATION Of ENVIRONMENTAl DOCUMENT

a. PROJECTS JHAT ARE SUBJECT TO DFG FEES D 1. ENVIRONMENTAL IMPACT REPORT (PUBLIC RESOURCES C0DE?21152) 0 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE ?21080(C) D 3. APPLICATION FEE WATER DIVERSION (STATE WATfil! 11ES0VRCES colm!Ol. aoARD ONLY)

0 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS

D 5. CQUNTY ADMINISTRATIVE FEE (REQUIRED FORa-1 THROUGH a-4 ABOVE)

Fish & Game Code ?711.4(e)

S 3,271.00 S 2,354.75

' 850.00

S 1.112.00

s 50.00

'

0.00

'

$

0.00

o.oo

$

0.00

s o.oo

b, PROJECTS THAT ARE EXEMPT FROM DFG FEES 0 1. NOTICE OF EXEMPTION ($50,00 COUNTY ADMINISTRATIVE FEE REQUIRED)

$ 50.00

s,_ _~o,,.o~o_ _

D 2, A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE

DEPARTMENT OF FISH & GAME, DOCUMENTING THE DFG'S DETERMINATION THAT THE PROJECT

WILL HAVE NO EFFECT ON FISH, WILDLIFE AND HABITAT, OR AN OFFICIAL, DATED RECEIPT/

PROOF OF PAYMENT SHOWING PREVIOUS PAYMENT OF THE DFG FILING FEE FOR THE*SAME PROJECT IS ATTACHED {S50.00 COUNTY ADMINISTRATIVE FEE REQUIRED)

DOCUMENT TYPE: [J ENVlRONMENTAL IMPACT REPORT O NEGATIVE DECLARAT!ON

$ 50,00

,,_ _. ,o, ,.o~o_ _

c. NOTICES THAT ARE NOT?UBJECTTO DFG FEES OR COUNTY ADMINISTRATIVE FEES

0 NOTICE OF PREPARATION

tJ NOTICE OF INTENT

NO FEE

S,_ __,,N,.OceF,cEEs

a. OTHER: Notice of AvailabUity

FEE (IF APPLICABLE): s._--0~.o-o__

-0.-0_0 _ 9. TOTAL RECEIVED ...........,...................,,.,,??,.. ,, .... .,,,................................,,,,,................................................................ $_ _

"NOTE: 'SAME PROJEC1" MEANS NO CHANGES. IFTHE DOCUMENT SUBMlTIEO IS NOT THE SAME (OTHER THAN OATES). A "NO EFFECT DETERMINATION' LEITER FROM THE DEPARTMENT OF FISH AND GAME FOR THE SUBSEQUENT FILING OR THE APPROPRIATE FEES ARE REQUIRED.

THIS FORM MUST BE COMPLETED AND ADACHED TO THE FRONT OF ALL CEQA DOCUMENTS LISTED ABOVE {{NCWO!NGCOPIES,

SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND TWO {2) COPIES, JF THERE ARE AITACHMENTS, PLEASE

PROVIDE THREE (3) SETS OF ATIACHMENTS FOR SUBMISSION. (YOUR ORIGINAL WIU BE RETURNED ro YOU AT THE TIME OFFILINGJ

CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE TO: SANTA CLARA COUNTY CLERK-RECORDER

PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game Code ?711.4/b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT

OF FISH AND GAME FOR THE LATEST FEE INFORMATION.

-

~ ... NO PROJECTSHALL 8? OPERATIVE. VESTED, OR FINAL, NOR SHALL LOCAL GOVERNMENTPERMITS FOR THE PROJECT BE VAl/D, UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECnON ARE PAID.? Fish & Game Code ?711.4(c)(3)

(Faas Effective 01-0f-20I9)

Receipt: 19-105541

Regina Alcomendras Santa Clara County

Clerk-Recorder (408) 299-5686

. cJerkrecorder _org

Product

Name

Extended

CEQA

ENVIRONMENTAL FILING

#Pages Document#

$0.00

4 ENV22216

Document Info:

CITY OF PALO ALTO

_-----?-------? ___ _?--???---- -----?. -?-- ___________ ......------------- ____ Filing.Type -?--- ...____ ---??---?? _______ ?- _________ .,------... -----? _ _?--~-------. ---_____?__

Total

$0.00

Change (Cash)

$0.00

5/31/19 8:48 AM nkhamphilath

PLEASE KEEP FOR REFERENCE

State of Californ!a - Department of Fish and Wildlife

2019 ENVIRONMENTAL FILING FEE CASH RECEIPT D,FW 753.Sa (REV. 12/01/18) Previously DFG 753.Sa

SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. LEAD AGENCY

CITY OF PALO ALTO

COUNTY/STATE AGENCY OF FILING

SANTA CLARA

PROJECT TITLE

LEAOAGENCY EMAIL

NEWELL ROAD BRIDGE REPLACEMENT PROJECT

RECEIPT N!JMBER:

ENV22216

STATE CLEARINGHOUSE NUMBER {ffappficable)

DATE

05/31/2019

DOCUMENT NUMBER

PROJECT APPLICANT NAME

MICHEL JEREMIAS

PROJECTAPPLICANT ADDRESS

250 HAMILTON AVENUE, 5TH FLOOR

PROJECT APPLICANT (Check appropriate box)

[E] Local Public Agency

D School District

PROJECT APPLICANT EMAIL

CITY PALO ALTO

STATE

CA

PHONE NUMBER

(650) 329-2129

ZIP CODE

94301

D Other Special District

D State Agency

0 Private Entity

CHECK APPLICABLE FEES:

D Environmental Impact Report (EIR) D Mitigated/Negative Declaration (MND)(ND) D Certified Regulatory Program (CRP) document - payment due direcUy to CDFW

0 Exempt from fee D Notice of Exemption (attach) D CDFW No Effect Determination (attach)

D Fee previously paid (attach previously issued cash receipt copy)

$3,271.00 $2,354.75 $1,112.00

$ _ _ _ _ _ _ _ __ $ _ _ _ _ _ _ _ __

?--------~

D Water Right Application or Petition Fee (State Water Resources Contrd Board only)

$850.00 $

0 County documentary handling fee

$

D Other

$

PAYMENT METHOD:

D Cash O Credit D Check !Z] Other

TOTAL RECEIVED $

AGENCY OF FILING' PRINTED NAME AND T!TLE

Nina Khamphilath, Deputy County Clerk-Recorder

$0.00

ORIGINAL? PROJECT APPLICANT

COPY? CDFWIASB

COPY? LEAD AGENCY

COPY - COUNTY CLERK

DFW753.5a (Rav, 12012018)

 ................
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