HomeMy WebLinkAboutAdministrative Permit APX2007018A - PlansSTATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENC.
FACILITY SKETCH (Floor Plan)
CALIFORNIA DEPARTMENT OF SOCIAl SERVICES
COMMUNITY CARE LICENSING
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Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketc~ ·~~st label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/re~itlJ!PI~client~c'-irdren. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster PIM). ·Show roomsiz:es (e.g. 8.5 x
12. Kee close to \scale. Use the s ace below. See back for ard sketch. ••••••• '
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L1C 999 (3199)
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STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGEN.
FACILITY SKETCH (Yard)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
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Jhe yaid sketch should show all buildings in the yard including the home (with no detaiO, garage and-i1orilge building.
Include walks, driveways, play area, fences,· gates. Show any potential hazardous area su'b~POOls,!9~rtiJJJe storage,
animal pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use theo6{)·ace-below.----
•••••• -ADDRESS:
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STATE OF CAliFORNIA -HEALTH AND HUMAN SERVICES AGE. •
FACILITY SKETCH (Floor Plan)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
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APPlicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sket~h ~u·st label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/re~it!e"tttclient~ltziidren. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plclif); ·3how room ;izes (e.g. 8.5 x
12. Kee close to scale .. Use the s ace below. See back for ard sketch. ••••••• .
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Lie 999 (3199)
SiATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGEN.
FACILITY SKETCH (Yard)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
.The yard sketCh should show all buildings in the yard including the home (with no detail), garage and-;;;~e' building.
Include walks, driveways, play area, fences, gates. Show any potential hazardous area sucb.q~ pools,:g~l'bage storage,
animal pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use the.sJ1arJ! below.----•
ADDRESS:
<t.~ l d--A
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STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGEl' •
FACILITY SKETCH (Floor Plan)
CALIFORNIA DEPARTMENT OF SOCIAl SERVICES
COMMUNITY CARE LICENSING
.... ~ • • ••••
•
APPlicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor ske~h rg"st label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/res~fltS:cfient~wOiWen. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster PIM). • ~how room ~izes (e.g. 8.5 x
12. Kee close to scale. Use the s ace below. See back for ard sketch. . :. : •• : • • :
r I !1' .c. .. I-,.-. ·-ttOV\ ~11!P.. •
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LIe 999 (3199)
STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENe
FACILITY SKETCH (Yard)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
•••• 1
The yard sketch should show all buildings in the yard including the home (with no detail), garage and'itorlilge building .
• lnclUde walks, driveways, play area, fences, gates. Show any potential hazardous area su~b~POOls,:g~rbaJJe storage,
animal pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use the~d below.-----ADDRESS:
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