Do I need a notary for this form?

No. The owner signs the form without a notary and certifies under penalty of perjury. If claiming the item 3 exemption, include a written letter from a licensed plumbing contractor.

How do I submit the plumbing fixture certification form?

Give the completed form to the Building Official at or before final inspection. The form lists the City Hall address but does not specify another filing method.

When is this form required?

The form says to complete it when fixtures are unavailable for the Building Official to inspect or compliance cannot be verified from product markings and data.

What information does the form request?

It requests the property address and permit number, an owner certification or exemption claim, the owner’s printed name and signature, and the date.

Monte Sereno, CA · Santa Clara County

No notary required

Water-Conserving Plumbing Fixture Certification Form

Property owners use this form to certify that a residence’s plumbing fixtures meet water-conserving requirements or qualify for an exemption.

What this form is

The City of Monte Sereno uses this form when fixtures cannot be inspected or compliance cannot be verified from product markings and data. For covered residential additions, alterations, or improvements, the owner provides the property address, permit number, certification or exemption basis, printed name, signature, and date; the form is given to the Building Official at or before final inspection.

Who needs it

Property owners seeking final permit approval for a covered residential project may need this form if the Building Official cannot verify fixture compliance.

How to submit it

Give the completed form to the Building Official at or before final inspection. The form lists City Hall at 18041 Saratoga-Los Gatos Road, Monte Sereno, but does not provide a separate filing method.

About notarization

This form is signed without a notary; the owner certifies under penalty of perjury, and an exemption under item 3 requires a licensed plumber’s written letter.

How to submit this form

1
Download The Form
Download the Water-Conserving Plumbing Fixture Certification Form.
2
Complete The Form
Enter the property address and permit number, select the applicable certification or exemption, then print and sign your name and date.
3
Gather Required Letter
For the item 3 exemption, obtain a written letter from a licensed plumbing contractor.
4
Give It To The Building Official
Provide the completed form to the Building Official at or before final inspection.

Frequently asked questions

Do I need a notary for this form?: No. The owner signs the form without a notary and certifies under penalty of perjury. If claiming the item 3 exemption, include a written letter from a licensed plumbing contractor.
How do I submit the plumbing fixture certification form?: Give the completed form to the Building Official at or before final inspection. The form lists the City Hall address but does not specify another filing method.
When is this form required?: The form says to complete it when fixtures are unavailable for the Building Official to inspect or compliance cannot be verified from product markings and data.
What information does the form request?: It requests the property address and permit number, an owner certification or exemption claim, the owner’s printed name and signature, and the date.

Need something notarized?

This Water-Conserving Plumbing Fixture Certification Form doesn’t need a notary — but if you have another Monte Sereno form that does, a commissioned online notary can help.