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CEQA Filing 17-LL Community CenterC i t~ o~ CAM~~e ~( 7D Iv. Firs+,St, C~~,pb~ 11, ~q~. R 5 00~ GULI''vT ~~' ~~ ~ I ~ ~~ ~ ~ ~ ~ ! -~:~ ~ ~'~~ ~ .-y~, ~t;sn .....~¢ ?~q Gl~ Regina Alcomendras Santa Clara County Clerk-Recorder ' (408) 299-5688 https://www. sccgov. org Receipt: 17-7496 Product Name - Extended CEQA ENVIRONMENTAL FILING $50.00 # Pages 2 ' Document # ENV20600 Document Info: CITY OF CAMPBELL ......_...._ ............._............._......_...._........................ Filing Type ........................................................_....._._............._.........___...._....._.__... ___- .._.._.. _.....__.._......__._.__.__.._..__..-.____..__.. E .-~-------~~-----.._._._._...--------....._----T_...__...._._....__...___....__.._....._ Total $50.00 Tender (Check) $50.00 Check # 260668 Paid By customer 1113117 8:40 AM mlouie PLEASE KEEP FOR .REFERENCE ~ F~1 ~ ~S~ r . ~J . ~ C ~_, w ~;f~ ~ Sr 1 ,f ~~~~ ~_ t Q ~ State of California - Department of Fish and Wildlife " - ,~ 20'16 ENVIRONMENTAL FILING-FEE CASH RECEIPT DFW 753.5a (Rev. 12/15!15} Previously DFG 753.5a SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. LEAD AGENCY LEADAGENCY EMAIL CITY OF CAMPBELL ~,v~iv i ~ iv ~r~i ~ nv~ivv i yr f ILIIYV SANTA CLARA DOCUMENT NUMBER 1 PROJECT TITLE PROJECT 17-LL: COMMUNITY CENTER AREA DESIGN AND CONSTRUCTION PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER FREDRICK HO (408) 866-2156 PROJECT APPLICANT ADDRESS CITY STATE ZIP CODE . 70 N. FIRST STREET CAMPBELL CA 95008 PROJECT APPLICANT (Check appropriate box)' ® Cocal Public Agency ~ • ^ School District ^ Other Special District ~ ^ State Agency ~ Private Entity CHECK APPLICABLE FEES: ^ Environmental Impact Report (EIR) $3,070.00 $ ^ Mitigated/Negative Declaration (MND)(ND) $2,210.25 $ ^ Certified Regulatory Program document (CRP) $1,043.75 $ ® Exempt from fee ® Notice of Exemption (attach) ^ CDFW No Effect Determination (attach) • ^ Fee previously paid (attach previously issued cash receipt copy) • ^ Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ ® County documentary handling fee $ $50.00 ^ Other ~ $ PAYMENT METHOD: ^ Cash ^ Credit . ®Check : ^ Other. TOTAL RECENED $ $50.00 SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE ~( Mike Louie, Deputy County Clerk-Recorder RECEIPT NUMBER: ENV20600 TATE CLEARINGHOUSE NUMBER (If applicable) DATE 01/13/2017 ORIGINAL -PROJECT APPLICANT COPY - CDFW/ASa COPY -LEAD AGENCY COPY -COUNTY CLERK DFW 753.5a (Rev. 20151215) County of Santa Clara Office of the County Clerk-Recorder Business Division County Government Center 70 West Redding Street, E. Wing, 1s' Floor San Jose, California 95110 (408) 299-5688 , CEQA DOCUMENT DECLARATION • ENVIRONMENTAL FILING FEE RECEIPT PLEASE COMPLETE THE FOLLOWING: 1. •LEAD AGENCY: City Of Camnhatt 2. PROJECT TITLE: G LrA'T ~,~`~~~~ I Iii o ~ - T ~ -- "Y,I,T iaso L ~¢Q' 17-LL: Community Center 3. APPLICANT NAME: Fredrick Ho 4. APPLICANT ADDRESS: 70 N. First Street, Cam 5. PROJECT APPLICANT IS A: I] Local Public Agency 6. NOTICE TO BE POSTED FOR 30 DAYS. Play Area Design and Construction PHONE: 408 866 2156 CA 95008 ^ School District ^ Other Special Dis.~trict ^ State Agency ^ Private Entity 7. CLASSIFICATION OF ENVIRONMENTAL DOCUMENT a. PROJECTS THAT ARE SUBJECT TO DFG FEES .. ^ 1. ENVIRONMENTAL IMPACT REPORT (PUBLIC RESOURCES CODE §21152) ^ 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE§21080(C) ^ 3. APPLICATION FEE WATER DNERSION tsTaTe wA~R ResouRCes corirao~ soaao oN~vl ^ 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS ^ 5. COUNTY ADMINISTRATIVE FEE (REQUIRED FOR a-t THROUGH a-4 ABOVE) Fish 8 Game Code §711.4(e) b. PROJECTS THAT ARE EXEMPT FROM DFG FEES Cl 1. NOTICE OF EXEMPTION ($50.00 COUNTYADMINISTRATlVE FE $ 3,078.25 $ 0.00 $ 2,216.25 $ 0.00 $ 850.00 $ 0.00 $ 1,046.50 $ 0.00 $ 50.00 $ 0.00 • E REQUIRED). $ 50.00 $ 50.00 ^ 2. A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE DEPARTMENT OF FISH 8 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 ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) . . _ DOCUMENT TYPE; ^ ENVIRONMENTAL•IMPACTREPORT ^ NEGATIVEDECLARATION $ 50.00 $ 0.00 c. NOTICES THAT ARE NOT SUBJECT TO DFG FEES OR COUNTY ADMINISTRATIVE FEES ^ NOTICE OF PREPARATION ^ NOTIC 8. OTHER: E OF INTENT NO FEE $ NO FEE 9. TOTAL RECEIVED ................ FEE (IF APPLICABLE): $ ........................... ................................................................................ $ 50.00 *NOTE: "SAME PROJECT" MEANS NO CNAIVGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATE '- DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH AND GAME FOR THE SUBSE DENT FILING OR THE.APPROPRIATE F REQUIRED. S), A "NO EFFECT THIS FORM MUST BE COMPLETED AND ATTACHED TO THE FRONT OF ALL CEQA DOCUME EES ARE SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND TWO (2) COPIES. (YOUR ORIGINAL WILL B TO YOU AT THE TIME OF FILING.) NTS LISTED ABOVE INCLUDING O lES) CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE T0: SANTA CLARA COUNTY CLERK-RECORD E RETURNED PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game Code §711.4(b); PLEASE CHECK WITH THIS OFFI OF FISH AND GAME FOR THE LATEST FEE INFORMATION. CE AND THE DEPARTMENT °... NO PROJECT~SHALL BE OPERATIVE, VESTED, OR FINAL, NOR SHALL LOCAL GOVERNMENT PERMITS FOR THE PRO UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECTION ARE PAID." Fish & Game Code §711.4(c)(3) JECT BE VALID, (Fesa EftscUve 01-01-2017) Santa Clara County -Clerk-Recorder Office State of California File Number: ENV20600 ' ENVIRONMENTAL FILING No. of Pages: 2 Total Fees: $50.00 . File Date: 01/13/2017 Expires: 02/12/2017 REGINA ALCOMENDRAS, Clerk-Recorder By: Mike Louie, Deputy Clerk-Recorder Regina Alcomendras Santa Clara County Clerk-Recorder (408) 299-5688 https://www.sccgov.org . . Receipt: 17-7452 Product Name Extended . CEQA ENVIRONMENTAL FILING $50.00 # Pages 2 Document # ENV20599 Document Info: CITY OF CAMPBELL Filing Type E Total $50.00 Tender. (Check) $50.00 Check# 260669 Paid By customer PLEASE KEEP FOR REFERENCE ~ 1113117 8:28 AM mlouie @' ® ` State of California -Department of Fish and Wildlife <~ ...~ 2016 ENVIRONMENTAL FILING FEE CASFI RECEIPT DFW 753.5a (Rev. 12/15/15) Previously DFG 753.5a RECEIPT NUMBER: ENV20599 ~. STATE CLEARINGHOUSE NUMBER (if applicable) SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. LEAD AGENCY LEADAGENCY EMAIL DATE CITY OF CAMPBELL 01/13/2017 COUNTY/STATE AGENCY OF FILING " ~ DOCUMENT NUMBER SANTA CLARA PROJECT TITLE PROJECT 15-GG/17GG JACK FISCHER PARK IMPROVEMENT PROJECT PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER FREDRICK HO (408) 866-2156 PROJECT APPLICANT ADDRESS ~ CITY STATE ZIP CODE 70 N. FIRST STREET CAMPBELL CA 95008 PROJECT APPLICANT (Check.appropriate box) . ® Local Public Agency ^ School District ^ Other Special District ^ State Agency ^ Private Entity l CHECK APPLICABLE FEES: ^ Environmental Impact Report (EIR) s $3,070.00 $ ^ Mitigated/Negative Declaration (MND)(ND) - $2,210.25 $ ^ Certified Regulatory Program document (CRP) $1,043.75 $ ® Exempt from fee ® Notice of Exemption (attach) _ ^ CDFW No Effect Determination (attach) ^ Fee previously paid (attach previously issued cash receipt copy) ^ Water Right Application or Petition Fee (State Water Resources .Control Board only) $850.00 $ ® Gounty documentary handling fee $ $50.00 ^ Other $ PAYMENT METHOD: ^ Cash ^ Credit ®Check ^ Other TOTAL RECENED $ $50.00 . SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE ~( Mike Louie, Deputy County Clerk-Recorder ORIGINAL -PROJECT APPLICANT COPY - CDFW/ASB COPY -LEAD AGENCY COPY -COUNTY CLERK DFW 753.5a (Rev. 20151215) Santa Clara County -Clerk-Recorder Office State of California County of Santa Clara ~~~ L'^'T~- o ~ ~~ I 1 ~ File Number: ENV20600 ' Office of the County Clerk-Recorder. ,~ ,~ ~~ ~i ENVIRONMENTAL FILING Business Division ~ ~ r No. of Pages: 2 County Government Center ~ `~-y ,~ , Q~ ~'rA cy~ - Total Fees: $50.00 File Date: 01/13/2017 9 70 West Hedding Street, E. Wing, 1 Floor San Jose; California 95110 (408) 299-5688 Expires: 02/12/2017 CEQA DOCUMENT DECLARATION REGINA ALCOMENDRAS, Clerk-Recorder . By: Mike Louie, Deputy Clerk-Recorder ENVIRO(JMENTAL FILING FEE RECEIPT PLEASE COMPLETE THE FOLLOWING: 1. LEAD AGENCY: City of Campbell 2. PROJECT TITLE: Project 17-LL: Community Center Play Area Design and Construction 3. APPLICANT NAME: Fredrick Hp PHONE: 408 866 2156 4. APPLICANT ADDRESS: 70 N. First Street, Campbell CA 95008 _ ~ _ _ _ 5. PROJECT APPLICANT IS A: l7 Local Public Agency ^ School District ^ 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. APPLICATION FEE WATER DIVERSION IsTnTe wnTEH RESOURCES corlrRO~ Bongo oN~vl $ 850.00 $ 0.00 ^ 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS $ 1,046.50 $ 0.00 ^ 5. COUNTY ADMINISTRATIVE FEE (REQUIREp FOR a-1 THROUGH a-4 A80VE) $ 50.00 $ 0.00 Fish & Game Code §711.4(e) b. PROJECTS THAT ARE EXEMPT FROM DFG FEES D 1. NOTICE OF EXEMPTION ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED). $ 50.00 $ 50.00 ^ 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 ($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 QF PREPARATION Q NOTICE OF INTENT NO FEE $ NO FEE e. OTHER: FEE (1F APPLICABLE): $ 9. TOTAL RECEIVED ....:................................................................................................................................................... $ 50.00 '`NOTE: "SAME PROJECT" MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATES), A "NO EFFECT DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH 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 O IES) SUBMITTED FOR FILING; WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND TWO (2) COPIES. (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 8 Game Code p711.4(b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT OF FISH AND GAME FOR THE LATEST FEE INFORMATION. ' ... NO PROJECT rSHALL 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) ' (FBea Eftactiva 01-01.2017) ®~~ ~~~~ ~ NOTICE OF EXEMPTION 0 0 1. G~ (JkC){pRJ T©: Office of Planning and Research From: City of Campbell 1400 Tenth Street, Room 121 Planning Department Sacramento, CA 95814 70 North First Street Campbell, CA 95008 x County Clerk's Office Santa Clara County - 70 W. Hedding, 1St Floor, East Wing San Jose, CA 95110 (3 copies & cover sheet filled out by Planner) Project Title: Proiect 17-LL: Communitv Center Play Area Design and Construction Project Location -Specific:. New Playground equipment and safety surfacing located at the south end of the existing worts fields at Campbell Communitv Center at 1 West Campbell Ave .. Project Location -City: Campbell Project Location -County: Santa Clara Description of Project: The scope of work includes but is not limited to the following• removal of portion of existing turf sports field, relocation of ptcntc area Installation of new play equipment protective safety surfaces fencing_plays?round satety slgnage, IrrlQatton and landscape Name of Public Agency Approving Project: City of Campbell Name of Person or Agency Carrying Out Project: Fredrick Ho, Senior Civil Engineer E:~empt 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)); ® Categorical Exemption, State type and section number: New Construction or Conversions of Small Structures 15303 ^ Statutory Exemptions. State code number: Reasons why project is exempt: Proiect consists of new playground structure and associated safety surfacing-- Lt~ad Agency C~nntact Person: Fredrick Ho Area'Code/T'elephone/Extension; (408) 866-2156 If filed by applicant: 1. Attach certified document of exemption finding. + 2.: Ids a notice of exen'iption been filed by the public agency approving the project? ^ Yes ^ No .may , `fie Sil;natui ~ ~ Date: ~2(~, I-~, Title: -Senior Civil Engineer "- redric Ho ® Signed by lead Agency Date received for filing at OPR: ^ Signed by Applicant S:17-LL Community Center Play Area DesignlDES1GN1Notice of Exemption.docx Regina Alcomendras Santa Clara County Clerk-Recorder (408) 299-5688 https://www. sccgov. org Receipt: 17-7452 Product Name CEQA ENVIRONMENTAL FILING # Pages Document # Document Info: Filing Type Total Tender (Check) Check # 260669 Paid By customer PLEASE KEEP FOR REFERENCE Extended $50:00 2 ENV20599 CITY OF CAMPBELL E $50.00 $50.00 1 1/13/17 8:28 AM mlouie _~ @ ' State of California - Department of Fish and Wildlife ~,~ ~ 2016 ENVIRONMENTAL FILING FEE. CASH RECEIPT DFW 753.5a (Rev. 12/15/15) Previously DFG 753.5a RECEIPT NUMBER: ENV20599 STATE CLEARINGHOUSE NUMBER (If applicable) SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. LEAD AGENCY LEADAGENCY EMAIL DATE CITY OF CAMPBELL 01/13/2017 COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER SANTA CLARA PROJECT TITLE PROJECT 15-GG/17GG JACK FISGHER PARK IMPROVEMENT PROJECT PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER FREDRICK HO (408) 866-2156 PROJECT APPLICANT ADDRESS _ CITY STATE ZIP CODE 70 N. FIRST STREET CAMPBELL CA 95008 PROJECT APPLICANT (Check appropriate box) ® Local Public Agency ^ School District ~ Other Special District ~ State Agency ~ Private Entity CHECK APPLICABLE FEES: ^ Environmental Impact Report (EIR) ^ MitigatedlNegative Declaration (MND)(ND) ^ Certified Regulatory Program document (CRP) ®Exempt from fee ® .Notice of Exemption (attach) ^ CDFW No Effect Determination (attach) ^ Fee previously paid (attach previously issued cash receipt copy) $3,070.00 $ $2,210.25 $ $1,043.75. $ LJ Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ ® County documentary handling fee $ $50.00 ^ Other $ PAYMENT METHOD: ^ Cash ^ Credit ®Check ^ Other TOTAL RECEIVED $ ~ $50.00 . SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE X Mike Louie, Deputy County Clerk-Recorder ORIGINAL -PROJECT APPLICANT COPY - CDFWlASB COPY -LEAD AGENCY COPY -COUNTY CLERK DFW 753,5a (Rev. 20151215) ~;' County of Santa Clara Office of the County Cierk-Recorder Business Division County Government Center 70 West Redding Street, E. Wing, IS` Floor San Jose, California 95110 (408) 299-5688 CEQA DOCUMENT DECLARATION Santa Ciara County -Clerk-Recorder•Office State of California ~~~ ~,i`I",T o File Number: ENV20599 ~~-'~' ENVIRONMENTAL FILING * ~~ - ~' No. of Pages:- 2 ~ ~~ ~ Q-~ Total Fees: $50.00 ~-Tq ~~P File Date: 01/13/2017 Expires: 02/12/2017 ' REGINA ALCOMENDRAS, Clerk-Recorder By: Mike Louie, Deputy Clerk-Recorder ENVIRONMENTAL FILING FEE RECEIPT PLEASE COMPLETE 7HE FOLLOWING: 1. LEAD AGENCY: City of Campbell 2. PROJECT TITLE: Project 15-GG/17GG Jack Fischer Park Improvement Project • 3. APPLICANT NAME: Fredrick Ho PHONE: 408 866 2156 4. APPLICANT ADDRESS: 70 N. First StreetT Campbell CA 95008 5. PROJECT APPLICANT 1S A: D Local Public Agency ^ School District ^ 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. APPLICATION FEE WATER DIVERSION IsrnrE wnTea Resouaces coN~o~ sonao oN~vl $ 850.00 .$ 0.00 ^ 4. PROJECTS SUBJECT.TO CERTIFIED REGULATORY PROGRAMS $ 1,046.50 $ 0.00 ^ 5. 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 D 1. N071CE OF EXEMPTION ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) $ 50.00 $ 5D.00 ^ 2. A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE DEPARTMENT OFFISH & 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 ($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 (lF APPLICABLE): $ 9. TOTAL RECEIVED ..........................................:..................:.......................................................................................... $ 50.00 "'NOTE: "SAME PROJECT' MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATES), A "NO EFFECT DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH 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 IINCLUDING COPIES) SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL {WET SIGNATURE) AND TWO (2) COPIES. (YOUR ORIGINAL WILL BE RETURNED TO YOU AT THE T/ME OF FILING.) \ • CHECKS F•OR 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 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 8 Game Code §711.4(c){3) (Feea E1bcUre 01-01-2017) __ tiF . C q ~~ : , .., r NOTICE OF EXEMPTION ~. _ rJk Cti ARV To: Office of Planning and Research From: City of Campbell 1400 Tenth Street, Room 12'1 Planning Department Sacramento, CA 95814 70 North First Street Campbell, CA 95008 x County Clerk's Office Santa Clara County 70 W. Hedding, ls` Floor; East Wing San Jose, CA 95110 (3 copies & cover sheet filled out by Planner) Project Title: Proiect 15-GG/l7-GG: Jack Fischer Park Improvement Project Project Location -Specific: Play;~'ound equipment and safety surfacing will be replaced at Jack Fischer Park located at the intersection of Abbott Avenue and~Pollard Road Project Location -City: Campbell Project Location -County: Santa Clara Description of Project: The scope of work includes but is not limited to the following• demolition of existing lp ayground structures, installation of new play equipment protective safety surfaces wood fencing and.play~round safety s~gnage. . Name of Public Agency Approving Project: City of Campbell Name of Person or Agency Carrying Out Project: Fredrick Ho, Senior Civil Engineer Exempt Status: (check one) ^ Ministerial (Sec. 2.1080(b)(1); 15268); ^ Declared Emergency (Sec. 21080(b)(3); 15269(a)); ^ Emergency Project (Sec. 21080(b)(4); 15269(b)(c)); ® Categorical Exemption, State type and section number: Existing Facilities 15301 (c) ^ Statutory Exemptions. State code number: Reasons why.project is exempt: Proiect consists of installin new playground equipment in existingpark location and involves no expansion beyond currently existing footprint Lead Agency Contact Person: Fredrick Ho Area Code/Telephone/Extension: (408) 866-2156 If filed by applicant: 1. Attach certified document of exemption finding. 2. Ha~a1~ 'ce of exemption been filed by the public agency approving the project? ^ Yes ^ No Signat e: ~= / Date: CZ - (~- (,~ Title: Senior Civil Engineer ~redrick ~o ~- ® Signed by lead Agency Date received for filing at OPR: ^ Signed by Applicant S:\17-GG Citywide Park Play~ound Renovations\Design\Notice of Exemption.docx