Healdsburg, CA · Sonoma County
PEX Flushing Procedure Certification
This certification records an owner’s or contractor’s commitment to follow required flushing and fixture-tagging procedures for new PEX plumbing installations in Healdsburg.
What this form is
Owners or contractors use this certification for new construction where PEX is the initial plumbing piping; it does not apply when PEX replaces an existing pipe system. It describes the required flushing and fixture-tagging procedure and asks for the signer’s name, signature, job site address, and permit number. The form states that final permit approval depends on compliance with the applicable requirements.
Who needs it
An owner or contractor installing PEX as the initial plumbing piping in new construction completes this certification.
How to submit it
The form lists the Community Development Department, Building Division, at 401 Grove Street, Healdsburg, CA 95448-4723, and [email protected]; it gives no submission method.
About notarization
This certification is signed without a notary; it does not identify any notarized or sworn attachment, so the owner or contractor signs it.
How to submit this form
- 1
Download The Certification
Download the PEX Flushing Procedure Certification PDF.
- 2
Complete The Form
Enter the owner’s or contractor’s printed name, job site address, and permit number, then sign the certification.
- 3
Check For Attachments
The certification does not list any required attachments.
- 4
Contact The Building Division
The form lists the Building Division’s address and email but does not specify how to submit the certification.
Frequently asked questions
- What does the PEX Flushing Procedure Certification cover?
- It certifies compliance with flushing and fixture-tagging procedures for PEX installed as the initial plumbing piping in new construction.
- Who completes this certification?
- The form provides signature and printed-name fields for an owner or contractor, along with the job site address and permit number.
- Do I need a notary for the PEX Flushing Procedure Certification?
- No. This certification is signed without a notary, and it does not identify any notarized or sworn attachment.
- How do I submit the PEX Flushing Procedure Certification?
- The form lists the Community Development Department, Building Division, and its address and email, but does not state a submission method.
Need something notarized?
This PEX Flushing Procedure Certification doesn’t need a notary — but if you have another Healdsburg form that does, a commissioned online notary can help.