California Daycare Application Forms Checklist

The Application Packet at a Glance

The LIC 279 Application Packet is the core document package you submit to your regional CCLD office to apply for a Family Child Care Home license. It's not a single form — it's a bundle of forms, statements, certificates, and supporting documents that must all be present and complete before CDSS will process your application.

Submitting an incomplete packet doesn't get you a partial review. It gets returned with a list of what's missing, and you restart the processing clock when you resubmit. Getting every piece right the first time saves you weeks.

The Required Forms

LIC 279 — Application for a Family Child Care Home License

This is the primary application form. It captures your personal information, the address where you'll operate, the type of license you're applying for (Small or Large), your proposed capacity, and basic information about your household.

Key details to get right: the facility address must be your primary residence — California doesn't allow FCCHs in a home that isn't your primary living space. If you've recently moved, be prepared to document that the address is your primary residence.

LIC 279B — Current Children in Your Home Report

This supplemental form documents every child currently living in or regularly present in your home — your own children, foster children, relatives' children, anyone under 18. CDSS needs this to calculate capacity, because your own children under 10 count toward your licensed capacity when they're present during operating hours.

LIC 508 — Criminal Record Statement

Every adult (18+) living in your home must complete a separate LIC 508 form. This is a signed disclosure statement covering criminal history, not the Live Scan itself — the Live Scan is a separate process. The LIC 508 asks each adult to disclose convictions. Discrepancies between the LIC 508 disclosure and what the Live Scan reveals can delay your application or trigger additional review.

LIC 610A — Emergency Care and Disaster Plan

Your written emergency and disaster plan covering:

• Evacuation routes from your home (primary and secondary)
• Designated relocation sites appropriate to your home and disaster plan
• How you'll track and account for every child during an evacuation
• Emergency supply locations (first aid kit, water, flashlight, emergency contact list)
• A drill schedule — you must conduct and log evacuation drills at least every six months

The plan doesn't need to be elaborate, but it must be specific to your address. A generic template won't pass inspection — the analyst will check that your relocation sites are real places and your evacuation routes work for your actual floor plan.

LIC 999A — Facility Sketch

A detailed floor plan of your home and outdoor space. This isn't an architectural drawing — a hand-drawn sketch on the form is fine — but it must show:

• Every room and its designated use (playroom, napping room, kitchen, off-limits bedroom, etc.)
• Door and window locations
• Exit pathways
• Outdoor play area dimensions and fencing
• Location of fire extinguishers and first aid supplies
• Any locked rooms or areas off-limits to children

The analyst compares this sketch to your actual home during the pre-licensing inspection. Discrepancies (a room labeled "off-limits" that's actually being used for care) trigger citations.

LIC 9217 — Pre-Licensing Readiness Guide

This is a self-assessment checklist that CDSS provides to help you evaluate your readiness before the inspection. You complete it, sign it, and include it in the packet. It's essentially a preview of what the licensing analyst will check during the home visit — safety hazards, equipment requirements, record-keeping systems.

Completing it honestly (rather than just checking every box) is in your interest. If you identify gaps on the 9217 before submitting your application, you have time to fix them before the inspection. If the analyst finds them during the visit, you get a deficiency notice and a correction deadline.

LIC 9149 — Property Owner/Landlord Consent (conditional)

This form is only required if you're a renter and you plan to operate at expanded capacity (more than 6 children in a Small FCCH, or more than 12 in a Large FCCH). At standard capacity, you only need to provide written notification to your landlord — not consent.

If you do need the LIC 9149, your landlord must sign it. California law (SB 234) protects your right to operate a daycare at standard capacity regardless of your landlord's wishes, but expanded capacity requires their written agreement.

Supporting Documents

Beyond the numbered forms, your packet must include:

Proof of orientation completion — the certificate you received after completing the mandatory CDSS Family Child Care Home orientation. This certificate is valid for 12 months — if it's expired by the time you submit, you need to retake the orientation.

Training certificates — copies of your EMSA health and safety training certificate (with official validation sticker), pediatric CPR/first aid card, and mandated reporter training completion certificate.

TB clearance documentation — negative TB screening results for every adult in the household, dated within the past 12 months.

Immunization documentation — proof of current Tdap, MMR, and seasonal flu vaccinations for all resident adults and any assistant, or valid medical exemptions (SB 792 requirement).

Application fee — $73 for a Small FCCH, $140 for a Large FCCH. Non-refundable, included with the packet. Check or money order payable to CDSS.

Experience verification (Large FCCH only) — documented proof of at least one year of experience as a licensed Small FCCH operator or as a teacher, director, or administrator at a licensed child care center, on official letterhead.

Where to Get the Forms

All LIC-numbered forms are available from two sources:

1. CDSS website — the Forms and Publications section, organized alphabetically. Search the I-L list for LIC forms.
2. Your regional CCLD office — they can provide printed copies and will confirm which forms are current. Form versions occasionally change; using an outdated form can delay processing.

Download the forms from the CDSS website rather than using third-party templates. Third-party versions sometimes modify layouts, add fields, or use outdated numbering — all of which can cause processing issues.

Filing Order

The forms themselves can be completed in any order, but they depend on prerequisites that have a fixed sequence:

1. Complete orientation (produces the orientation certificate, valid 12 months)
2. Complete Live Scan for all adults (requires your facility identification number from the welcome letter)
3. Complete training (EMSA, CPR/first aid, mandated reporter, TB screening)
4. Complete all LIC forms and gather supporting documents
5. Submit the complete packet to your regional CCLD office with the application fee

The 12-month expiration on the orientation certificate creates a deadline: submit the application packet before the certificate expires. A 12-week plan is a useful planning framework, but actual completion varies.

Our California Home Daycare Licensing Guide includes a document tracker that maps every form and certificate to its deadline, so you're assembling the packet in the right order and nothing expires before you submit.

See more California guides →