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RM-2017-15, CEQASanta Clara County - Clerk -Recorder Office State of California 'County ®f Santa Clara�Gou>vT� He Number: ENV21203 ®face off the County Clerk -Recorder �'r�`�, I I ��i ° ENVIRONMENTAL FILING Business Division No. of Pages: 2 County Government Center �� ��Q.e Total Fees: $50.00 �' Tq c� File Date: 11/15/2017 70 West Hedding Street, )E. Wing, V ]Floor Expires: 12/15/2017 San Hose, California 95110 ( 408) 299-5688 REGINA ALCOMENPRAS, Clerk -Recorder CEQA DOCUMENT DECLARATION By: Mike Louie, Deputy -Clerk -Recorder ENVIRONMENTAL FILING FEE RECEIPT PLEASE COMPLETE THE FOLLOWING: 1. LEAD AGENCY: City of Cupertino 2. PROJECT TITLE: RM -2017-15 3. APPLICANT NAME: Sddharan residence PHONE: 408-777-3308 4. APPLICANT ADDRESS: 20087 Somerset Dr Cupertino, Ca. 95014 5. PROJECT APPLICANT IS A: ❑ Local Public Agency ❑`School District 17 Other Special District ❑ State Agency ®Private Entity 6. NOTICE TO BE POSTED FOR 30 DAYS. 7. CLASSIFICATION OF ENVIRONMENTAL DOCUMENT a. PROJECTS THAT ARE SUBJECT TO DFG FEES ❑ 1. ENVIRONMENTAL IMPACT REPORT (PUBLIC 'RESOURCES CODE §21152) $ 3,078.25 $ 0.00 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE §21080(C) $ 2,216.25 $ 0.00 ❑ 3.- APPLICATIONFEE WATER DIVERSION (STATE WATER RESOURCES CONTROL BOARD ONLY) $ 850.00 $ 0.00 C7 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS $ 1,046.50 $ 0.00 ®'S. COUNTY ADMINISTRATIVE FEE (REQUIRED FOR a-1 THROUGH a-4 ABOVE) $ . 50.00 $ 0.00 Fish & Game Code §711.4(e) b. PROJECTS THAT ARE EXEMPT FROM DFG FEES ® 1. NOTICE OF EXEMPTION ($50:00 COUNTY ADMINISTRATIVE FEE REQUIRED) $ 50.00 $ 50.00 [I 2.:A COMPLETED " CEQA FILING FEE NO EFFECT DETERMINATION':FORM" FROM THE DEPARTMENT 00 FISH & GAME, DOCUMENTING THE DFG 'S.DETERMINATION THAT THE PROJECT WILL HAVE NO EFFECT ON FISH; WILDLIFE AND HABITAT,`OR AN OFFICIAL, DATED RECEIPT I PROOF OF PAYMENT SHOWING?REVIOUS PAYMENTOF THE DFG FILING" -FEE FOR THE *SAME PROJECT IS ATTACHED ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) DOCUMENT TYPE: ® ENVIRONMENTAL IMPACT,'REPORT ❑ NEGATIVE DECLARATION $ 50:00 $ 0.00 c. NOTICES THAT ARE NOT SUBJECT TO DFG FEES OR COUNTY ADMINISTRATIVE FEES ❑'NOTICE OF PREPARATION ® NOTICE OF INTENT NO FEE, $ NO FEE 8. OTHER: FEE (IF APPLICABLE): $ 9. TOTAL RECEIVED ....................... ......... ............................................ ........ .. $ 5000 *NOTE: "SAIWEPROJEC7- MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DAT,ES);'A "NO EFFECT DETERMINATION" LETTER FROM THE DEPARTMENT OF FIS_ H'AND GAME FOR THE SUBSEQUENT FILING OR THE APPROPRIATE FEES ARE REQUIRED. THIS FORM MUST BE COMPLETED'AND ATTACHED TO THE FRONT OF ALL CEQA DOCUMENTS LISTED ABOVE (INCLUDING COPIES) SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET I' AND TWO (2) COPIES. IF THERE ARE ATTACHMENTS, `PLEASE PROVIDE THREE (3) SETS OF ATTACHMENTS FOR SUBMISSION. (YOUR ORIGINAL WILL BE RETURNED TO YOU AT THE TIME OF FILING.) CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE TO: SANTA CLARA COUNTY CLERK -RECORDER PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game CodeA711.4(b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT OF FISH AND GAME FOR THE LATEST FEE INFORMATION. "...NO PROJECT SHALL BE OPERATIVE, VESTED, OR FINAL; 'NOR SHALL LOCAL GOVERNMENT PERMITS FOR THE PROJECT BE VALID, UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECTION ARE PAID." Fish & Game Code §711.4(c)(3) (Fees Effective 01-01-2017) To: County Clerk -Recorder 70 W. Hedding Street, 1st Floor East Wing -Business Division San Jose, CA 95110 Project Title: RM -2017-1 Project Location - (be specific): 20087 Somerset Dr Project Location - (City): Cupertino Project Location - (County): Santa Clara Description of Project: Minor Residential Permit to allow a portion of a single story addition to encroach into the rear yard setback Name of Public Agency approving project: City of Cupertino Name of Person or Agency carrying out project: Sridharan residence Exempt Status: (check one) Ministerial (Sec. 21080(b)(1);15268); Declared Emergency (Sec. 21080(b)(3); 15269(a)); _ Emergency Project (Sec. 21080(b)(4);15269(b)(c)); 2L -Categorical Exemption. State type and section number: 15301 _Statutory Exemption. State code number: Reasons why project is exempt: existing facilities Lead Agency Contact Person: Teffrey Tsumura Area code/telephone number X408) 777-1356 Signature: Date: 4 Title: Assistant Planner