STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PROPERTY OWNER/LANDLORD CONSENT
FAMILY CHILD CARE HOME
Health and Safety Code, Sections 1597.44(d) and 1597.465(d) require, in
part, that providers who lease or rent their residence obtain written consent
from their property owner when they plan to provide care for more than six
and up to eight children at a Small Family Child Care Home, or for more than
12 and up to 14 children at a Large Family Child Care Home. If you plan to
increase the capacity of your Family Child Care Home, as specified, please
have your property owner complete this consent form.*
I give my consent for
(PRINT PROPERTY OWNER/LANDLORD NAME)
who resides at
(PRINT APPLICANT/LICENSEE’S NAME)
to increase the
(PRINT FACILITY ADDRESS)
CHECK ONE:
[ ] S
mall Family Child Care Home capacity to provide care for more than 6 and up to 8
children.
or
[ ] Large Family Child Care Home capacity to provide care for more than 12 and up to
14 children.
(PROPERTY OWNER/LANDLORD SIGNATURE) (DATE)
*Property owner consent is not required if you plan to care for 6 or fewer children in your Small Family Child
Care Home or for 12 or fewer children in your Large Family Child Care Home.
Maintain this form attached to the license and
keep on file at the licensed Family Child Care Home.
LIC 9149 (8/14)
click to sign
signature
click to edit
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