According to California Plumbing Code, a cleanout is required for every horizontal drain line that runs 5’ or longer. So…
A plumbing cleanout is an access point installed on a drainage line for the purpose of accessing that line with drain cleaning equipment. Most houses have them on their drain lines. The problem is that, quite often, they are not really as “accessible” as you would think. In fact, most of them are located under your house, in the crawlspace (assuming you have a house with a crawlspace).
These cleanouts are not really “accessible” for a few reasons. One reason is that the plugs (that keep the sewage from flowing under your home) are usually frozen solid, and nearly impossible to remove. They have been there since your house was built, and were installed very tightly.
The second reason is, even if you can get the plug removed, all of the sewage that is backed up in that pipe will now drain under your home (as well as all over the plumber who removed the plug). Remember, if your line is backed up it is likely holding gallons of sewage. You do not want that draining out in your crawlspace (or basement).
The third reason is that, even if you did get the cap off, and did not flood your crawlspace, it is usually next to impossible to get drain cleaning machines down there.

That really depends on the situation. Many smaller drain lines, such as kitchen sinks, bathtubs, and the like can be cleaned without having to have a plumbing cleanout. There are sometimes exceptions to that (such as in the case of back-to-back fixtures, etc.), but often there are other ways.
In the case of mainline backups, however, there are not very many good alternatives
If your sewer main is backed up, and you do not have an accessible cleanout, your plumber will be hard pressed to be able to find a way to do a proper cleaning of your sewer line. These are usually your only options:
Hopefully, we have helped you understand a little more about cleanouts. If you are wondering whether or not you could benefit from a cleanout install, one of our professional San Jose plumbers would be more than happy to give you a free assessment.
Just give Allstar Plumbing a call.