Child Care Centers - Section A & B

This section for Child Care Centers are for filing an application (Part A) for the following:

-Child Care Center    -School-Age Centers   -Infant Care Centers

-Child Care Centers for Mildly ill Children

-Toddler Programs

  Licensing Form


A1. Application for Child Care Center License (LIC 200A)

Identifies applicant(s) and facility for licensure.

A2. Applicant Information (LIC 215)

Submitted by applicant(s), e.g., individual(s), chief executive officer(s) of a corporation, general partners of a partnership, or controlling partner(s) in a limited liability company.

A3. Criminal Record Statement (LIC 508)

Identifies applicant(s) and facility for licensure.

A4. Designation of Facility Responsibility (LIC 308)

Identifies the person authorized by the licensee to accept responsibility for the facility in the licensee's absence.

A5. Administrative Organization (LIC 309)

Identifies the organization of a corporation, the board of officers, and anyone having a beneficial ownership of 10 percent or more in the corporation.  Also required for a partnership, limited liability company, and public agency application.

A6. Monthly Operating Statement (LIC 401)

Establishes estimated gross profit based on income from children's care, less operation costs.

A7. Balance Sheet (LIC 403)

Compilation of total assets and liabilities to establish equity of applicant(s). A credit check may be obtained to verify financial ability to operate the facility.

A8. Financial Information Release and Verification (LIC 404)

Provides financial information that is verified by a bank or other financial institution. (Applicant completes Section 1 only.)

A9. Personnel Report (LIC 500)

Show all planned employee positions. Includes days and hours staff will be on duty.


A10. Personnel Record (LIC 501)

To be completed by site director if other than applicant

A11. Health Screening Report - Facility Personnel (LIC 503)

Verifies health of applicant(s) and site director to effectively perform duties as required.


A12. Emergency Disaster Plan (LIC 610)

Plan developed by applicant to enable facility to handle any emergency that may arise and to protect the safety and well-being of each child.

A13. Earthquake Preparedness Checklist (LIC 9148)

List of earthquake safety measures that must be attached to the Emergency Disaster Plan (LIC 610)


A14. Facility Sketch (LIC 999)

Required for all indoor and outdoor space.  The front of the form is for a floor plan; the back is for a yard sketch.


A15. Local Fire Inspection Authority Information (LIC 9054)

To be completed by any applicant who intends to serve non-ambulatory children or children with disabilities or special health care needs.

Part B

The Licensing application for Part B is a biography of what type of program you want to serve and the experiences you can provide for the program you choose. 

The Vendors Point of View section of Part B created a tool that provides you an outline on what Community Care Licensing Application is looking for.

VENDORS . Point of View


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