Form LIC 999A Facility Sketch (Floor Plan) - Family Child Care Home - California

Form LIC999A is a California Department of Social Services form also known as the "Facility Sketch (floor Plan) - Family Child Care Home". The latest edition of the form was released in February 1, 2005 and is available for digital filing.

Download an up-to-date fillable Form LIC999A in PDF-format down below or look it up on the California Department of Social Services Forms website.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
FACILITY SKETCH (Floor Plan) - Family Child Care Home
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Please identify areas which will be “off limits” to children. Door and window exits from the
rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x 12). Keep close to scale.
Use the space below. See back for yard sketch.
FACILITY NAME:
ADDRESS:
1
LIC 999A (2/05)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
FACILITY SKETCH (Floor Plan) - Family Child Care Home
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Please identify areas which will be “off limits” to children. Door and window exits from the
rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x 12). Keep close to scale.
Use the space below. See back for yard sketch.
FACILITY NAME:
ADDRESS:
1
LIC 999A (2/05)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
FACILITY SKETCH (Yard) - Family Child Care Home
The yard sketch should show all buildings in the yard including the home (with no detail), garage and storage building.
Include walks, driveways, play area, fences, gates. Please identify areas which will be “off limits” to children. Show any
potential hazardous areas such as pools, garbage storage, animal pens, etc. Show the overall yard size. Try to keep the
sizes close to scale. Use the space below.
FACILITY NAME:
ADDRESS:
2
LIC 999A (2/05)

Download Form LIC 999A Facility Sketch (Floor Plan) - Family Child Care Home - California

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