California Code of Regulations
Title 23 - Waters
Division 2 - Department of Water Resources
Chapter 2.7 - Model Water Efficient Landscape Ordinance
Appendix C - Sample Certificate of Completion
CERTIFICATE OF COMPLETION
This certificate is filled out by the project applicant upon completion of the landscape project.
PART 1. PROJECT INFORMATION SHEET
| Date | ||
| Project Name | ||
| Name of Project Applicant | Telephone No. | |
| Fax No. | ||
| Title | Email Address | |
| Company | Street Address | |
| City | State | Zip Code |
Project Address and Location:
| Street Address | Parcel, tract or lot number, if available. | |
| City | Latitude/Longitude (optional) | |
| State | Zip Code | |
Property Owner or his/her designee:
| Name | Telephone No. | |
| Fax No. | ||
| Title | Email Address | |
| Company | Street Address | |
| City | State | Zip Code |
Property Owner
"I/we certify that I/we have received copies of all the documents within the Landscape Documentation Package and the Certificate of Completion and that it is our responsibility to see that the project is maintained in accordance with the Landscape and Irrigation Maintenance Schedule."
| ___________________________ | |
| Property Owner Signature | Date |
Please answer the questions below:
1. Date the Landscape Documentation Package was submitted to the local agency__________
2. Date the Landscape Documentation Package was approved by the local agency__________
3. Date that a copy of the Water Efficient Landscape Worksheet (including the Water Budget Calculation) was submitted to the local water purveyor__________
PART 2. CERTIFICATION OF INSTALLATION ACCORDING TO THE LANDSCAPE DOCUMENTATION PACKAGE
"I/we certify that based upon periodic site observations, the work has been completed in accordance with the ordinance and that the landscape planting and irrigation installation conform with the criteria and specifications of the approved Landscape Documentation Package."
| Signature* | Date | |
| Name (print) | Telephone No. | |
| Fax No. | ||
| Title | Email Address | |
| License No. or Certification No. | ||
| Company | Street Address | |
| City | State | Zip Code |
| * Signer of the landscape design plan, signer of the irrigation plan, or a licensed landscape contractor. | ||
PART 3. IRRIGATION SCHEDULING
Attach parameters for setting the irrigation schedule on controller per ordinance Section 492.10.
PART 4. SCHEDULE OF LANDSCAPE AND IRRIGATION MAINTENANCE
Attach schedule of Landscape and Irrigation Maintenance per ordinance Section 492.11.
PART 5. LANDSCAPE IRRIGATION AUDIT REPORT
Attach Landscape Irrigation Audit Report per ordinance Section 492.12.
PART 6. SOIL MANAGEMENT REPORT
Attach soil analysis report, if not previously submitted with the Landscape Documentation Package per ordinance Section 492.6.
Attach documentation verifying implementation of recommendations from soil analysis report per ordinance Section 492.6.
1. New Appendix C filed 9-10-2009; operative 9-10-2009 pursuant to Government Code section 11343.4 (Register 2009, No. 37).
2. Repealer and new Appendix C filed 9-15-2015; operative 9-15-2015. Exempt from OAL review and submitted to OAL for printing only pursuant to Governor's Executive Order No. B-29-15 (4-1-2015) (Register 2015, No. 38).
