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Home My WebLink AboutAdministrative Permit APX2012002 - PlansSTATE OF CAUFORNIA - HEALTH AND HUMAN SERVICLo GENCY I CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING 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 s ace below. See back for rd sketch. FACILITY NAME: A ESS:t O T 1 1 y t ,.I L y 1 - 1 lV RarV(AD t it it III!i itit !I, • 1' 1 1 R 114 i i 1 1 f" i! ! L ! l i I I II I .:I I!+!1 ilil I It 1 1 1 1 1 1 •i i : I I I I ! ! I I till {11;1' +I. I 1111 !i 111+ I1 ! I I ! sz< LIC 999A (205) ry { t 1, scAI \,JWbOWsFo --:wlr floNs I V I I+,f ii ' it yi;1! Io 1111 li I i ,!f r I I I i ,i+ ! '1w11J .4 JY I I ! I 1 1t. i!!; i I I f 1 ! I I I r I i I 1 fI III11 I. '-(I kcJ<e}v r) jJ STATE OF CALIFORNIA - HEALTH AND HUMAN SERVIC&NCY 0 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 s ace below. See back for and sketch. FACILITY NAME:ADDRESS:o1 -r-id 'SkkfAo O\U e, LIC 999A (21D5) 1 STATE OF CALIFORNIA - HEALTH AND HUMAN SERV NCY 0 COMMUNITY CALIFORNIA DEPARTMENT OF REL S ERVICINS 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: °l1 O 'f i G 0(j LIC 999A (2M5) 2 . JF CALIFORNIA - HEALTH AND HUMAN SERVI06NCY 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 dose to scale. Use the space below. i! t ADDRESS: 0 1f ci ULM, g2,&q(v i t-L i 1! I ?! !!( I! i, ' ! 0 FACILITY NAME: i_i 1 t fT 4 - _? -I t -'s-I - • t-' T-r-, --r r • - :-cam ,------f-'j ! ! ! ! ! I I [T j •••:•'• ! ',• •'i i_. __,--1-I I 1 ! t `Imo-, i-r- , t , •----• ri-i---J-j -r ; ! !!I i !I j ! ( `I j {I t I { I • I • I ' •r- H+i-'_["---1 t!j! ! 1!! I i-I _'1 '• • I ,!- I !i { S ! # _j t j-1- I__I I ! •• • r- - -•=- -- ,- -- ---t - r 4 I(11 -LI ,fi'-1-;------i C-,r--i -i -,----.-c•-= _t» - _4-4:'T_ --I- _, 17- t I ! J t III I i 1 7 ! ! I iT Ii i[;I I[Il11t1[ililiI;___it 'Ll --j! T I ! I 1! I! r;= I { IYFP14-1- -r -1 i+! i i! i{ j I I!i !!!! ! i ! , t L 1 ! ! f ! -j-t----T-` I i ! ! !r rt ! 1 1 ,!! 't 1 I -+-a----r_- L LJ r t 4 1 I ,I i i! i- -1 L ILL: tr } UC 999A (2)05)2 STATE OF CALffORNIA - HEALTH AND HUMAN sERVICES ENC? 0 EMERGENCY DISASTER PLAN FOR FAMILY CHILD CARE HOMES Type or print clearly. Post next to phone. Keep current - Return a copy to the licensing office. LICENSEE NAME: M Si A1U.. r 1. 'EMERGENCIES - LIFE THREATENING - Call 9-1-1 - Tell them: Number Calling from: HOME ADDRESS: MAJOR CROSSROAD: HOME DIRECTION FI"OM CROSSROAD: Smu'n 2. EMERGENCY NAMES AND TELEPHONE NUMBERS (In addition to 9-1-1) Fire/Paramedics: "1ILts,*--5t_( (1 Red Cross: i tl-1-LA -53oo fincnitai- q tCli c -GaAs}ml?-w ia-( ()fficpa of FmPfnRnr v .SiP.n ir.P_C' 1 , Z' -1oc5 Lice nsing: Ambulance:-714--io5--2-59OL 114 c(eo -01HI 0^6f -crehwiff•Child Protective Services: Poison Control: }JUA aa -"1 tip-(- 55 90D .. 2 -1-7- - t 222 GAS CO. PHONE: 3. FACILITY EVACUATION - Some disasters require evacua tion of the building. Using a copy of the Facility Skovb (LIC 999A), show arrows for the safest way to exit rooms. Be sure that exit doors are not locked from the inside. In the event of fi 0get eve ryone out, follow the escape routes, meet at a prearranged location, account for eve ryone , do not let anyone return to the guiding and call the fire department.&6$000 • 4. TEMPORARY RELOCATION SITE(S) - Some disasters require moving to a safe location. WtIh MMlocating, determine whether you need food, water, blankets and flashlight and meet at a prearranged easily accessible location. Be sure to obtair?permission from the•....property owner. .... NAME ADDRESS: NAMF ADDRESS:C/I-Z Ld"tr kbgz('1j(o 5. UTILITY SHUT OFF -indicate locations on the Facil' Sketch LIC 999A with the exit routes. GAS: of hose cwts;ea\ ELECTRI C <sF nt,wsL.T ti 0;(A\ WATER: U '1 OuSirls. C c1rN 6. EQUIPMENT LOCATION - The fire de artment ma hel FIRE EXTINGUISHER LOCATION: h11 i 1r %w% FIRE ALARM LOCATIOM (IF YOU HA ONE): CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUMTY CARE LICENSING Other: •PHONE •••• .'1 UAnew- `1503 • •.•. • ••••PHONE' ***ego 000 c, ELECTRIC CO. PHONE: Q-0 ~ LALi -S 12-5 WATER CO. PHONE: t idum T -I I U- SNO-6011 C, ou with installation information. SMOKE DETECTOR TiON: TYPE 7. OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, radio and other emergency equipment. LOCATION: Gt>, S-la ,(u e, uC 61 0A (6005) PUBLIC CALIFORNIA DEPARTMENT OF SOCIAL SERVICESSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVIC NCY E M40C COMMUNITY CARE LICENSINGGYCA50 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 s are below. See back for d sketch. FACLLRY NAME F Ror f2S u,AD" w1.+vDfaS u r ? I ! ? I I i ? 0 II t I ton 1 ? ? t l ? 1,111 I I 1 ?I 111 ti II1 ! ?? ?I i '4 i ADDRESS: scAI WWI F-` ..L . Wtt Down 1t! i I ? I iII?! ? { I ? ! ! ? ? ! ? ? Ill III III?. r t ACIC f tRo t I I I 1 'A9691 **lot ? ill? il! ? ! •1 Iil I!I ! II II ! ?! I ! ?! 1111 it 1111! II' 11I1i I I I r l l•• •' ? ! ? ! i i i I ? ! I i s! 4 • i ! [I I ? ``j i ti t r r - _i I i I ! ! ! ! .!• tllli • ? 1 i I 1 ! t t t I 1 ?Ir I t t i IwiNxi II II t i ! I I I!! 1 + ' UC 999A (2AS) t