Auburn, CA · Placer County
PEX Flushing Certification Form
Licensed plumbing contractors use this form to certify PEX installation and flushing for a project in Auburn.
What this form is
This form records a contractor’s certification that a PEX plumbing system meets installation requirements and that the flushing procedure was followed. The contractor completes it for the listed site and must have it available to the Building Inspector at final inspection. It asks for the site address, APN, owner, permit number, flushing details, contractor names, license numbers, signatures, and dates.
Who needs it
A licensed plumbing contractor doing PEX plumbing work at an Auburn site completes this form for the Building Department’s permanent records.
How to submit it
Complete the form and make it available to the Building Inspector at the time of final inspection, as the form directs.
About notarization
This form needs no notary; the contractor affirms under penalty of perjury and signs and dates the certification.
How to submit this form
- 1
Download The Form
Download the PEX Flushing Certification Form for the project.
- 2
Complete The Project Details
Enter the site address, APN, owner, permit number, and the date and name for the first fill and flush.
- 3
Sign And Date The Certification
Provide the contractor names and license numbers, then sign and date the certification.
- 4
Make It Available At Final Inspection
Have the completed form available to the Building Inspector at the time of final inspection.
Frequently asked questions
- Do I need a notary for the PEX Flushing Certification Form?
- No. The contractor signs and dates the certification without a notary and affirms the statements under penalty of perjury.
- How do I submit the PEX Flushing Certification Form?
- Complete the form and have it available to the Building Inspector at the time of final inspection, as the form directs.
- Who should complete this form?
- The form is for contractor use only and says not to use it for an owner-builder site. It requests contractor names, license numbers, signatures, and dates.
- What information does the form ask for?
- It requests the site address, APN, owner, permit number, the date the system was first filled and flushed, and contractor certification details.