STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
PROPERTY OWNER/LANDLORD NOTIFICATION
FAMILY CHILD CARE HOME
As required by Health and Safety Code Section 1597.40(d), you are hereby notified as the
property owner or landlord of the property located at:
that
(PRINT FACILITY ADDRESS)
is currently or will be
(PRINT APPLICANT’S/LICENSEE’S NAME)
operating a licensed Family Child Care Home at this address.
The sole purpose of this notice is to advise you of the current use or intended use of the above
property. The property owner/landlord is prohibited by law from imposing any direct or indirect
restrictions on, or prohibitions against, the tenant’s operation of the Family Child Care Home
on the rental property, in accordance with Health and Safety Code Section 1597.40.
(APPLICANT/LICENSEE SIGNATURE) (DATE)
Maintain a copy of this completed form on file at the licensed Family Child Care Home.
LIC 9151 (8/14)
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signature
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