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

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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).