Health & Human Services Agency California Department of Social Services APPLICATION FOR A FAMILY CHILD HOME LICENSE LIC 279 Completed Form Examples and Samples

Explore practical examples and samples of the California Department of Social Services LIC 279 Application for a Family Child Care Home License. Learn how to accurately complete your CDSS licensing forms with our guided walkthroughs.
Health & Human Services Agency California Department of Social Services APPLICATION FOR A FAMILY CHILD HOME LICENSE LIC 279 has a moderate Form Complexity Index of 57/100 — Instafill’s AI completes it in under a minute.
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Completed LIC 279 California Department of Social Services form

Filling the California LIC 279 Family Child Care Home Application from Personal Correspondence

How this form was filled:

This example demonstrates how an AI can parse an informal email thread between co-applicants to automatically populate the complex LIC 279 form. By analyzing the narrative, the system intelligently identifies legal names, residence history, and licensing preferences, mapping them to the specific California Department of Social Services (CDSS) fields.

Source document used: Informal Co-applicant Planning Email

Hi Elena, I'm so excited we finally decided to move forward with the daycare business! I've been organizing our paperwork for the California LIC 279 application. I'll be the primary applicant; my full legal name is Sarah Jane Miller, and you can put me down as Sarah Miller. Since I've lived at our current house at 452 Oak Street, Sacramento, CA 95814 for the past five years, we don't need to worry about listing other counties. My phone number there is (916) 555-0129. Since my husband, Robert Mark Miller, lives with us, we'll list him as the other adult in the home. I spoke with the landlord, and he's totally fine with us running a small home operation for up to 8 kids—that seems perfect for us. We're planning to be open Monday through Friday, 7:30 AM to 5:30 PM. I remember that back in 2018, I held a small daycare license in Placer County under number 340212345, issued by the Placer County Licensing Agency in Auburn. I've already scanned the document for our records. Let's make sure we sign everything in ink when we meet on January 15th, 2026, at the city hall in Sacramento. I'm choosing English as my preferred language for all agency communications. Let me know if you need anything else before I submit this to the state!

Information used to fill out the document:

  • Primary Applicant: Sarah Jane Miller
  • Home Address: 452 Oak Street, Sacramento, CA 95814
  • License History: Licensed in 2018, Placer County, Lic# 340212345
  • Operating Capacity: Small Home (up to 8)
  • Operating Hours: Mon-Fri 7:30 AM-5:30 PM
  • Other Adults: Robert Mark Miller
  • Language Preference: English

What this filled form sample shows:

  • Contextual role identification (distinguishing between applicant and other adult residents)
  • Date normalization and validation
  • Geographic data parsing for address components
  • Mapping of colloquial 'daycare' terminology to official licensing categories

Form specifications and details:

Form Name: LIC 279
Agency: California Department of Social Services
Target Audience: Family Child Care Home Providers
Form Version: 2/23
Key Requirement: Evidence of compliance with health and safety standards
Categories: California health forms, California social services forms, health department forms, health services forms, human services forms, social service forms, social services forms
Created: July 28, 2026 12:30 AM
Completed LIC 279 California Department of Social Services form