Appendix C  Sample Certificate of Completion
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.
PART 4. SCHEDULE OF LANDSCAPE AND IRRIGATION MAINTENANCE
Attach schedule of Landscape and Irrigation Maintenance.
PART 5. LANDSCAPE IRRIGATION AUDIT REPORT
Attach Landscape Irrigation Audit Report.
PART 6. SOIL MANAGEMENT REPORT
Attach soil analysis report, if not previously submitted with the Landscape Documentation Package.
Attach documentation verifying implementation of recommendations from soil analysis report.
(Ord. 814-2015, 2016)