Family Child Care Home Property Owner/landlord Consent Form

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FAMILY CHILD CARE HOME
PROPERTY OWNER/LANDLORD CONSENT FORM
Property owner/Landlord consent for family child care home applicants and licensees who wish to
provide child care for 2 additional schoolage children, required by Health and Safety Code Sections
1597.44(d) and 1597.465(d):*
I _________________________________________________________________ give my consent for
(PRINT PROPERTY OWNER/LANDLORD NAME)
__________________________________________________________________ who resides at
(PRINT APPLICANT/LICENSEE’S NAME)
__________________________________________________________________ to care for 2 additional
(PRINT FACILITY ADDRESS)
schoolage children.
_______________________________________
___________________
(PROPERTY OWNER/LANDLORD SIGNATURE)
(DATE)
*If you do not provide care for two additional schoolage children, for a licensed capacity of either 8 or 14 children,
property owner consent is not required.
LIC 9149 ENG/SP (3/99)

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