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06-0181 (CONR)P.O. BOX 1504 w 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 06-00000181 Owner: Property Address: 53378 FREMONT WY EAST OF MADISON LLC APN: 767-200-9987P -330761- PO BOX 1482 Application description: NEW COMML - OTHER NON-RESIDENTIAL LA QUINTA, CA 92247 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 60856 AVG 0 4 LUUW cmr OF ean� Vo 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/12/06 Contractor: Applicant: Architect or Engineer: LUSARDI CONSTRUCTI 1570 LINDA VISTA D A ( SAN MA92° IV f (760)744-344-3 1333 AUG 02 2006 Lic. No.: 207287 CITY OF LA QUINTA FIml r ---------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: /A ,B LicenseNo.: 207287 Contractor: / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of ,property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) 1 am exempt under Sec. , B.&P.C. for this reason - Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury tha there is a construction lending agency for the performance of the work for which this permit is issued IS c. 097 Civ. C.1. Lender's Name: Lender's Address: LQPERMIT WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NATL FIRE INS Policy Number WC7169394 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �� Date: f'! Applicant: i t � L WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby -made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for i spection purposes. f, i Date:: Z A, Signature (Applicant or Agent): Application Number . . . . 06-00000181 r Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 464.00 Plan Check Fee 301.60 Issue Date . . . . Valuation . . . . 60856 Expiration Date 12/27/06 Qty Unit Charge Per Extension BASE FEE 414.50 11.00 4.5000 ---------------------------------------------------------------------------- THOU BLDG 50,001-100,000 49.50 Permit . . . ELEC-NEW COMMERCIAL Additional desc . Permit Fee . . . . 31.11 Plan Check Fee 7.78 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/27/06 Qty Unit Charge Per Extension BASE FEE 15.00 768.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 15.36 1.00 .7500 ---------------------------------------------------------------------------- EA ELEC POLE LIGHT .75 Permit . . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 12/27/06 Qty Unit Charge Per Extension --------------------------------- BASE : FEE 15.00 . . . MECHANICAL Additional desc . Permit Fee 59.00 Plan Check Fee 14.75 Issue Date Valuation . . . . 0 Expiration Date 12/27/06 Qty Unit Charge Per Extension BASE.FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 4.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 26.00 Permit . . . . . . PLUMBING LQPERDIIT Application Number . . . . . 06-00000181 x Permit . . . PLUMBING Additional desc . Permit Fee . . . . 154.50 Plan Check Fee 38.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/27/06 Qty Unit Charge Per Extension BASE FEE 15.00 15.00 6.0000 EA PLB FIXTURE 90.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 3.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 9.00 1.00 15.0000 EA PLB GAS METER 15.00 ------------------------------------------------------------------ Special Notes and Comments halfway house golf club.May 16, 2006 4:40:31 PM' jjohnson -----------------------------------------------------•----------------------- Other Fees . . . . . . . . ACCESSIBILITY PLAN REVIEW 46.40 ART IN.PUBLIC PLACES -COM 284.28 DIF CIVIC CENTER - COMM 119.80 ENERGY REVIEW FEE 46.40 DIF FIRE PROTECTION -COMM 34.56 STRONG MOTION (SMI) - COM 12.77 DIF STREET MAINT FAC -COMM 81.40 • DIF TRANSPORTATION - COMM 2021.37 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- -------- 7- ---------- Permit Fee Total 723 .61 .00 .00 723.61 Plan Check Total 362.76' .00 .00 362.76. Other Fee Total 2646.98 .00 .00 2646.98 Grand Total 3733.35 .00 .00 3733.35 LQPERMIT r C44.0 GcvL- see 66 _ CJs a'---- P.O. BOX 1504 AP�1CATfOONLY Building Q �r,'r� 78-495 CALLE TAMPICO Address 3-��D / r ,eA,&-i t4/6 LA QUINTA, CALIFORNIA 92253 op VYtQ ebion . L -t -c— Mailing Address �f/-;Z- I yaa,9 City lZip Tel. State Lic. alty & Classif. Lic. # Designer BUILDING: TYPE CONST. OCC. GRT A.P. Number rte, 767-X00' PNL 3aoZ6i Legal Description �f Project Description rL Ci�94A Zg btae Lic.t# L_117C 2— LICENSED COOONN"TRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civet penalty of not more than five hundred dollars ($500). D I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) D 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company D Copy is filed with the city. D Certified copy is hereby furnished. r CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Sq. Ft. Size No. No. Dw. Stories Units Newfil Add ❑ Alter ❑ Repair ❑ Demolition D Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing, ' S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE Certificate of Occupancy T-Vr44Qwara Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 53-378 FREMONT WY Use classification: COMMERCIAL (Halfway House Golf Club) Occupancy Group: B Owner of Building: EAST OF MADISON LLC Building Official Type of Construction: VN Building Permit No.: 06-181 Land Use Zone: RL Address: P.O. BOX 1482 City, ST, ZIP: LA QUINTA, CA 92247 By: STEVE TRAXEL Date: OCTOBER 25, 2007 A CONSPICUOUS PLACE "Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 Project Name: This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMM/IND.AMOUNT: DATE: RECEIPT: CHECK #: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Date: 05/25/06 Owner's Name: East of Madison LLC Phone No. (760) 393-5288 Project Address: 53-378 Fremont Way, La Quinta, CA Project Description: Golf Club Halfway House APN: 767-200-998 Tract #: Lot #'s: Type of Development: Residential Commercial 77 Industrial Total Square Feet of Building Area: 768 sq. Ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: 05/25/06 Signature: 1-1 SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Number of Sq.Ft. 768 sq. ft. Amount per Sq.Ft. $ .42 Amount Collected $ 322.56 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Leticia C. Torres, Facilities Analyst NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF"ES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. LT:c/mvdocs/devfees/certificate of compliance form tablesTO USC.doc 1/16/03 T ,4 :: LLITY NATIONAL Ti1LE COM:'iit; RECORDING REQUESTED BY WHEN RECORDED RETURN TO: MORGAN, LEWIS & BOCKIUS 300 SOUTH GRAND AVENUE, SUITE 300 LOS ANGELES, CALIFORNIA 90071 ATTENTION: ANTHONY CIASULLI, ESQ. -ITA" QaU—I R e 967— 0Ma (A1;L-0037 -oo7Jr _dV' j (SPACE ABOVE THIS LINE FOR RECORDER'S USE ONLY) Ail• 767-,P 0o -Oag� g -vro, '' " tified to be a true and correct`\ copy of Recorded P As Instrument No. �/c",rvs7AE of Official Records of County, California l By FIDELITY NATIONAL TITLE CM Transfer Tax: See separate statement, not for public record. GRANT DEED THIS INDENTURE, is made this Zq th day of r, 2005, by and between 120 ACRE PARTNERS, LLC (the "Grantor"), a Delaware limited liability company, formerly known as NRI-LQLP LAND, LLC, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215, and EAST OF MADISON, LLC (the "Grantee"), a Delaware limited liability company, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215. WITNESSETH: That Grantor, for and in consideration of the sum of Ten and No/100 U.S. Dollars ($10.00) to it in hand paid by Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to Grantee, its successors and assigns forever, the following described land (the "Property"), situate, lying and being in the County of Riverside, State of California, to -wit: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF. TO HAVE AND TO HOLD the same in fee simple forever. This conveyance is made subject to, and by acceptance of this Deed, Grantee accepts this conveyance subject to the following: (a) the zoning and other regulations imposed by governmental authorities, (b) taxes for the year of the transfer and all subsequent years, and (c) all easements, dedications, agreements, licenses, restrictions, covenants, conditions, rights-of-way and other matters affecting title then applicable to the Property as granted, imposed or suffered to be placed upon the Property by predecessors in title or Grantor. 1-LA/828730.1 ses_ ee Transfer Tax: See separate statement, not for public record. GRANT DEED THIS INDENTURE, is made this Zq th day of r, 2005, by and between 120 ACRE PARTNERS, LLC (the "Grantor"), a Delaware limited liability company, formerly known as NRI-LQLP LAND, LLC, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215, and EAST OF MADISON, LLC (the "Grantee"), a Delaware limited liability company, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215. WITNESSETH: That Grantor, for and in consideration of the sum of Ten and No/100 U.S. Dollars ($10.00) to it in hand paid by Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to Grantee, its successors and assigns forever, the following described land (the "Property"), situate, lying and being in the County of Riverside, State of California, to -wit: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF. TO HAVE AND TO HOLD the same in fee simple forever. This conveyance is made subject to, and by acceptance of this Deed, Grantee accepts this conveyance subject to the following: (a) the zoning and other regulations imposed by governmental authorities, (b) taxes for the year of the transfer and all subsequent years, and (c) all easements, dedications, agreements, licenses, restrictions, covenants, conditions, rights-of-way and other matters affecting title then applicable to the Property as granted, imposed or suffered to be placed upon the Property by predecessors in title or Grantor. 1-LA/828730.1 ,@t IN WITNESS WHEREOF, Grantor has caused these presents to be signed in its name on the day and year first above written. 120 ACRE PARTNERS, LLC, a Delaware limited liability company By: Nationwide Realty Investors, Ltd., an Ohio li liability company, its mana i g emb By: Irian' J. Ellis President/ Chief Operating Officer 017A 10 STATE OF G,LIF6�A ) F(apN KLI o ) ss. COUNTY OF RW ERSI$E ) The foregoin5, instrument was acknowledged before me this 2� day of 200 'by mk �. Ci I i5 as T'ft COO of Nationwide Realty Investors, Ltd., an Ohio limited liability company, managing member of 120 ACRE PARTNERS, LLC, a Delaware limited liability company, on behalf of said limited liability company, who is personally known to me or�tas pr�ri�ced-tlfellewingidenti€isatien and did take an oath. S , REGINA RHOADS ORMOND Attomey al Law Notary Public, Site of OND . rgrE o � my Commission147.03 R.C. 1-LA/828730.1 , )� �- "�" 6') , - - Printed Name: /2Ei iNA &b�105 O>tmwi'3 NOTARY PUBLIC State of California at Large My Commission Expires: EXHIBIT "A" Legal Description of Property 1-LA/828730.1 EXHIBIT "ONE" PARCEL 1: Order No. 9779892 - A The West 1/2 of the Northeast 1/4 of the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. PARCEL 2: The East 1/2 of the Northeast 1 /4 of the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. PARCEL 3: The West 1/2 of the Southeast 1/4 of the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. Excepting therefrom the Southerly rectangular 30 feet thereof as conveyed to the County of riverside by deed recorded October 29, 1959, as Instrument No. 89352 of Official Records. PARCEL 4: The East 1/2 of the Southeast 1/4 of the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. PARCEL 5: The North 1/2 of the Southwest 1/4 of the Northeast 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. PARCEL 6: The South 1/2 of the Southwest 1/4 of the Northeast 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to United States Government Survey thereof. Excepting therefrom the Southerly 30 feet thereof as conveyed to the County of Riverside by deed recorded October 19, 1959, in Book 2565, Page 20`3 of Official Records. STATEMENT OF DOCUMENTARY TRANSFER TAX (Pursuant to Section 11932 R&T Code) To: Registrar -Recorder County of Riverside Request is hereby made in accordance with the provisions of the Documentary Transfer Tax Act that the amount of tax due not be shown on the original document which names: 120 ACRE PARTNERS, LLC (as grantor) and EAST OF MADISON, LLC (as grantee) Property described in the accompanying document is located in the City of La Quinta, County of Riverside, State of California. The amount of tax due on the accompanying document is $ 151,933. So (County) and $ — (City). X Computed on full value of property conveyed, or Computed on full value less liens and encumbrances remaining at time of sale. Dated: , 2005 "GRANTOR": 120 ACRE PARTNERS, LLC, a Delaware limited liability company By: Nationwide Realty Investors, Ltd., an Ohio li� ted liability company, its Mana Member By: I-LA/828875.1 J. and Chief Operating Officer BOE -502-A REV. 6 (8-03) PRELIMINARY CHANGE OF OWNERSHIP REPORT ITo be completed by transferee (buyer) prior to transfer of subject property in accordance with section 480.3 of the Revenue and Taxation Code.] A Preliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office for the county where the property is located; this particular form may be used in all 58 counties of California. THIS REPORT IS NOT A PUBLIC DOCUMENT ESCROW #: 10071 -KC ORDER #: 9779859B & 9779892A SELLER/TRANSFEROR: 120 ACRE PARTNERS, LLC BUYER/TRANSFEREE: EAST OF MADISON, LLC ASSESSOR'S PARCEL NUMBER(S): per attached Exhibit 'one'. PROPERTY ADDRESS OR LOCATION: La Quinta Parcels, La Quinta, CA 92253 MAIL TAX INFORMATION TO: Nationwide Realty Investors, Ltd. 375 North Front Street, Suite 200 Columbus, OH 43215 FOR RECORDER'S USE ONLY NOTICE; A lien for property taxes applies to your property on January 1 of each year for the taxes owing in the following fiscal year, July 1 through June 30. One-half of these taxes is due November 1, and one-half is due February 1. The first installment becomes delinquent on December 10, and the second installment becomes delinquent on April 10. One tax bill is mailed before November 1 to the owner of record. If this transfer occurs after January 1 and on or before December 31, you may be responsible for the second installment of taxes due February 1. The property which you acquired may be subject toa supplement assessment in an amount to be determined by the Riverside County Assessor. For further information on your supplemental roll obligationi please call the Riverside County Assessor's Office. PART I: TRANSFER INFORMATION (please answer all questions) YES NO X.. A. Is this transfer solely between husband and wife (addition of a spouse, death of a spouse, divorce settlement, R etc.)? B. Is this transaction only a correction of the name(s) of the person(s) holding title to the property (for example, a name change upon marriage)? X C. Is this document recorded to create, terminate, or reconvey a lender's interest in the property? X D. Is this transaction recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner)? E. Is this document recorded to substitute a trustee under a deed of trust; mortgage, or other similar document? F. bid this transfer result in the creation of a joint tenancy in which the seller (transferor) remains as one of the joint tenants? X G. Does this transfer return property to the person who created the joint tenancy (original transferor)? H. Is this transfer of property: X 1. to a trust for the benefit of the Grantor i Grantor's spouse? _K— 2. to a trust revocable by the trans eror? _ X 3. to a trust from which the property reverts to the grantor within 12 years? 1. If this property is subject to a lease, is the remaining lease term 35 years or more including written options? • J. Is this transfer between parent(s) and child(ren)? ^ or from grandparent(s) to grandchild(ren)? • K. Is this transaction to rep ace a principal residence by a person 55 years of age or older?. Within the same county? Yes No X ' L. Is this transaction to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5? Within the same county? Yes No • If you checked yes to J, K or L, you may qualify for a property tax reassessment exclusion, wh�c�may result in lower taxes on your property. If you do not file a claim, your property will be reassessed. Please provide any other information that will help the Assessor to understand the nature of the transfer. If the conveying document constitutes an exclusion from a change in ownership as defined in section 62 of the Revenue and Taxation Code for any reason other. than those listed above, set forth the specific exclusions claimed; Meese answer a0 questions in each section. Na question does not apply, indicate with 'N/A." -Sign and date at bottom of second page. PART II: OTHER TRANSFER INFORMATION A. Date of transfer if other than recording date B. Type of transfer !please check appropriate box): Purchase Foreclosure Gift — Trade or Exchange X Merger, Stock, or Partnership Acquisition Contract of Sale - Date of anuact -' Inheritance - Date of. Death Other (please explain): Creation of Lease Assignment of a Lease _ Termination of a Lease _ Sale/Leaseback Date lease began Original term in years (including written options) _ Remaining term In years (including written options) Monthly Payment Remaining Term C. Was only a partial interest in the property transferred? Yes X No If yes, indicate the percentage transferred ' %. (PCORSB.WPF)(1 1-03) BOE -502-A REV. 6 (8.03) Please answer, to the best of your knowledge, all applicable questions, sign and date. if a question does not apply, indicate with VV/A. PART fit: PURCHASE PRICE AND TERMS OF SALE A. CASH DOWN PAYMENT OR value of trade of exchange (excluding dosing costs) Amount $ 12,484-70S B. FIRST DEED OF TRUST @ % interest for_ years. Pymts./Mo. = S (Prin. & Int. only) Amount $ E3- _ FHA ( Discount Points) _ Fixed rate _ Now loan _ Conventional _ Variable rate _ Assumed existing loan balance _ VA ( Discount Points) _ All Inclusive D.T. ($ Wrapped) _ Bank or savings & loan _ Cat -Vet _ Loan carried by seller Finance _ nance company Balloon payment _ Yes _ No Due Data Amount $ C. SECOND DEED OF TRUST @ % Interest for_ years. Pymts./Mo. = S (Prin. & Int. only) Amount $ _ Bank or savings & loan Fixed rate _ New loan _ Loan carried by seller _ Variable rate T Assumed existing loan balance Balloon payment Yes_ No' Due Date. Amount $ D. OTHER FINANCING: Is other financing involved not covered in (b) or (c) above? _ Yes _ No Amount $ Type @ _% interest for _years. Pymts./Mo. _ $ (Prin. & Int. only) _ .Bank or savings & loan _ Fixed rate _ New loan _ Loan carried by seller _ Variable rate _ Assumed existing loan balance Balloon payment _ Yes _ No Due Date Amount $ E. WAS AN IMPROVEMENT BOND ASSUMED BY THE BUYER? —Yes _ No Outstanding Balance: Amount $ F. TOTAL PURCHASE. PRICE (or acquisition price, if traded or exchanged, include real estate commission if paid) TOTAL ITEMS A THROUGH E $ 12,484,705. G. PROPERTY PURCHASED _ Through a broker _ Direct from seller _ From a family member _ Other /please explain) It purchased through a broker, provide broker's name and phone number: Please explain any special terms, seller concessions, or financing and any other information that would help the Assessor understand the purchase price and terms of sale: PART IV: PROPERTY INFORMATION A. TYPE OF PROPERTY TRANSFERRED: _ Single-family residence _ Agricultural _ Timeshare _ Multiple -family residence (no. of units: ► _ Co-op/Own-your-own _ Manufactured home X. Commercial/Industrial _ Condominium _ Unimproved lot Other (Description: i.e., timber, mineral, water rights, etc. ) B. TS—THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? _ Yes X No If yes, enter date of occupancy ! 20 or intended occupancy 1 20 (month) (dayl lyear) /month! (day! (Year! C. IS PERSONAL PROPERTY INCLUDED IN THE PURCHASE PRICE (i.e., furniture, farm equipment, machinery, etc.) (other than a manufactured home subject to local property tax)? _ Yes X No If yes, enter the value of the personal property included in the purchase price S (Attach itemized list of personal property.) D. IS A MANUFACTURED HOME INCLUDED IN PURCHASE PRICE? _ Yes No If yes, how much of the purchase pfice-is allocated to the manufactured home? $ Is the manufactured home subject to local property tax? --Yes _2LNo What Is the decal number? E. DOES THE PROPERTY PRODUCE INCOME? _ Yea X . No If yea, is the Income from: _ Lease/Rent Contract _ Mineral tights. _ Other (Please explain): F. WHAT WAS THE CONDITION OF THE PROPERTY AT THE TIME OF SALE? X GoodAverage _ Fair Poor _ Please explain the physical condition of this property and provide any other Information (such as restrictions, etc.) that would assist the Assessor in determining the value of the property: Land to be used for future development. CERTIFICATION OWNERSHIP TYPE (✓) ProP"etorddp — / certify that the foregoing /s true, correct and complete to the best of my knowledge and belief. P.te %Np Co,p,,.r;o„ — This declaration is binding on each and every co-owner and/or partner. onwt LLC g N N /CORPOR E ICER TITLE ' Brian LJ 1 is President & CEO SIGN TU NE O N E OFFICER . DATE Dy. Z8.2oo� NAME OrETITY rtyped -print 1 FEDERAL EMPLOYER 10 NUMBER EAST OF MADISON LLC — ��33o 36 ADDRESS tryped or printed! TELEPHONE NUMBER DAT C/o Nationwide Realty Investors,.Ltd. ( ) (NOTE: The Assessor may"contact you for additional Information.) 11 a document evidencing a change of ownership Is presented to the recorder for recordation without the concurrent filing of a preliminary change of ownership report, the recorder may charge an additional recording fee of twenty dollars ($20). 375 N. Front St., Suite 200 (PCORSS.WPF)(11-03) Columbus, 01.1 43215 iITOATA L i ii'LE C0 RECORDING REQUESTED BY �o WHEN RECORDED RETURN TO: MORGAN, LEWIS & BOCK] US 300 SOUTH GRAND AVENUE, SUITE 300 LOS ANGELES, CALIFORNIA 90071 ATTENTION: ANTHONY CIASULLI, ESQ. �W. 020-/c I Certified to be a true and correct 'opy of �C 'LiNr D:rm Recorded As Instrument No.,2 S-9��9Asn of Official Records of 1�12�,,..1 County, C lifornia By FIDELITY NATIONAL TITLE CO M $ U PAGE SIZE DA POOR NOCOR SfAF Nus^^. A I R L COPY LONG REFUND NCNG E. f767 .2/U -o131 "oqq' 60, W1 031 033 (SPACE ABOVE THIS LINE FOR RECORDER'S USE ONLY) 74.7-a/0-0It91 o�oj 6v5, a4(-.0 4t 04 Transfer Tax: See separate statement, not for public record. GRANT DEED THIS INDENTURE, is made this 26 th day of h9vl, 1 2005, by and between ND LA QUINTA PARTNERS, LLC (the "Grantor"), a Delaware limited liability company, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215, and EAST OF MADISON, LLC (the "Grantee"), a Delaware limited liability company, having its principal place of business at c/o Nationwide Realty Investors, 375 N. Front Street, Suite 200, Columbus, Ohio 43215. WITNESSETH:- That ITNESSETH: That Grantor, for and in consideration of the sum of Ten and No/ 100 U.S. Dollars ($10.00) to it in hand paid by Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to Grantee, its successors and assigns forever, the following described land (the "Property"), situate, lying and being in .the County of Riverside, State of California, to -wit: SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF. TO HAVE AND TO HOLD the same in fee simple forever. This conveyance is made subject to, and by acceptance of this Deed, Grantee accepts this conveyance subject to the following: (a) the zoning and other regulations imposed by governmental authorities, (b) taxes for the year of the transfer and all subsequent years, and (c) all easements, dedications, agreements, licenses, restrictions, covenants, conditions, rights-of-way and other matters affecting title then applicable to the Property as granted, imposed or suffered to be placed upon the Property by predecessors in title or Grantor. 1-LA/828727.1 IN WITNESS WHEREOF, Grantor has caused these presents to be signed in its name on the day and year first above written. ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company By: Nationwid Realty Investors, Ltd., an Ohio lim'.. � liability company, its By: 0"1 o STATE OF CCAtJF6RN1 A ) FRANkLtt-A ) ss. COUNTY OF.RFVTq6'DE ) Ifian j Ellis V President/Chief Operating Officer J� T foregoin instrument was acknowledged before me this 2V day of ' gnnihv raa A-0 (I S ac -P% (on of Nationwide Realtv Investors, Ltd., an Ohio limited liability company, managing member of ND La Quinta Partners, LLC, a Delaware limited liability company, on behalf of said limited liability company, who is personally known to me 0- —F—dueed the following identific-ati and did take an oath. rocPatnt, REGINA RHOADS ORMOND Attnmey at law Notary Public, State of Ohio 0 My Commission Has No Expiration `'� OF �:•, Sedan 147.03 R.C. 1-LA/828727.1 Printe Name: ;cl dv NOTARY PUBLIC State of California at Large My Commission Expires: EXHIBIT "A" Legal Description of Property 1-LA/828727.1 Order No. 9779859 - B EXHIBIT "ONE" PARCEL 1: The Northwest 1/4 of .the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian, according to United States Government Survey thereof. Excepting therefrom the Northerly 30.00 feet, lying within 52nd Avenue. Also excepting therefrom the Westerly 30.00 feet lying within Madison Street. Also excepting therefrom any portion lying within Tract No. 29894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive, and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of, Maps, Records of Riverside County, California. PARCEL 2: The North 1/2 of the Southwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, according to the Official Plat thereof. Excepting therefrom the Westerly 30.00 feet lying within Madison Street. Also excepting therefrom the Northerly 30.00 feet as conveyed to the County of Riverside by deed recorded October 19, 1959, as Instrument No. 89349, Official Records, which was not vacated by Resolution No. 2000-164 and 2000-163, recorded December 18, 2000, as Instrument No. 2000-502483, Official Records. Also excepting therefrom any portion lying within Tract 29894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County. PARCEL 3: A portion of the Southwest 1/4 of the Southwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian, in the City of La Quinta, County of riverside, State of California, according to the Official Plat thereof, described as follows: Commencing at the Southwest corner of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian, City of La Quinta, County of Riverside, State of California; thence along a line'that bears North 890 23' 56" East, a distance of 787.86 feet; thence North 080 15' 08" West a distance of 30.00 feet to the true point of beginning; thence along the same line distance of 1285.89 feet; thence North 890 23' 17" East, a distance of 529.89 feet; thence South 000 15' 8" East, a distance of 1285.89 feet; thence South 89° 23' 56" West a distance of 529.89 feet to the true point of beginning. Excepting therefrom any portion lying within Tract No. 29894-2; as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County, California. PARCEL 4: The Southwest 1/4 of the Northwest 1/4 of Section 10, Township 6 South, Range 7 East, 2 Order No. 9779859 - B San Bernardino Meridian, in the County of Riverside, State of California, according to the Official Plat thereof. Excepting therefrom any portion lying within Tract No. 19894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No.' 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County, California. PARCEL 5: The West 1/2 of the Southeast 1/4 of the, Southwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian, according to the Official Plat thereof. Excepting therefrom any portion lying within Tract No. 29894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County, California. PARCEL 6: The East. 1 /2 of the Southeast 1/4 -of the Southwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Base and Meridian, as shown by the United States Government Survey approved December 15, 1903 by the Surveyor General. Excepting therefrom the South 30.00 feet in public highway. Also excepting therefrom any portion lying within Tract No. 29894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County, California. PARCEL 7: The Southwest 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian. Excepting therefrom the Northerly rectangular 30.00 feet of the Southeast 1/4 of Section 10, Township 6 South, Range 7 East, San Bernardino Meridian, as conveyed to the County of Riverside by deed recorded October 19, 1959, as Instrument No. 89348 of Official Records of Riverside County, California. Also excepting therefrom any portion lying within Tract No. 29894-1, as shown by map on file in Book 305, Pages 14 through 22, inclusive and Amended Tract No. 29894-2, as shown by map on file in Book 327, Pages 56 through 88, inclusive, all of Maps, Records of Riverside County, California. PARCEL 8: Lots F, G and H of Tract No. 29894-1, in the City of La Quinta, as shown by map on file in Book 305, Pages 14 through 22, inclusive of Maps, in the Office of the County Recorder of Riverside County, California. 3 STATEMENT OF DOCUMENTARY TRANSFER TAX (Pursuant to Section 11932 R&T Code) To: Registrar -Recorder County of Riverside Request is hereby made in accordance with the provisions of the Documentary Transfer Tax Act that the amount of tax due not be shown on the original document which names: ND LA QUINTA PARTNERS, LLC (as grantor) and EAST OF MADISON, LLC (as grantee) Property described in'the accompanying document is located in the City of La Quinta, County of Riverside, State of California. The amount of tax due on the accompanying document is $ o (County) and $ — (City). X Computed on full value of property conveyed, or Computed on full value less liens and encumbrances remaining at time of sale. Dated: , j 2`b , 2005 "GRANTOR": ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company By: Nationwide Realty Investors, Ltd., an Ohio 'mited liability company, itsa g ng Mem r By: Bri J. Ellis President and Chief Operating Officer I-LA/828876.1 BOE -502-A REV. 5 (8-03) PRELIMINARY CHANGE OF OWNERSHIP REPORT [To be completed by transferee (buyer) prior to transfer of subject property in accordance with section 480.3 of the Revenue and Taxation Code.) A Preliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office.for the county where the property is located; this particular form may be used in all 58 counties of California. THIS REPORT IS NOT A PUBLIC DOCUMENT ESCROW #: 10071 -KC ORDER #: 9779859B & 9779892A SELLER(TRANSFEROR: ND LA QUINTA PARTNERS, LLC FOR RECORDER'S USE ONLY BUYER/TRANSFEREE: EAST OF MADISON, LLC ASSESSOR'S PARCEL NUMBER(S): per attached Exhibit 'one' PROPERTY ADDRESS OR LOCATION: La Quinta Parcels, La Quinta, CA 92253 MAIL TAX INFORMATION TO: Nationwide Realty Investors, Ltd. 375 North Front Street, Suite 200 Columbus, OH 43215 NOTICE: A lien for property taxes applies to your property on January 1 of each year for the taxes owing in the following fiscal year, July 1 through June 30. One-half of these taxes is due November 1, aind one-half is due February 1. The first Installment becomes delinquent on December 10, and the second installment becomes delinquent on April 10. One tax bill is mailed before November 1 to the owner of record. If this transfer occurs after January 1 and on or before December 31,,you may be responsible for the second installment of taxes due February 1. The property which you acquired may be subject to a supplement assessment in an amount to be determined by the Riverside County Assessor. For further information on your'supplemental roll obligation, please call the Riverside County Assessor's Office. . PART I: TRANSFER INFORMATION /please answer all questions! YES NO X A. Is this transfer solely between husband and wife (addition of a spouse, death of a spouse, divorce settlement, etc,)? _ X B. Is this transaction only a correction of the name(s) of the person(s) holding title to the property (for example, a name change upon marriage)? X C. Is this document recorded to create, terminate, or reconvey a lender's interest in the property? O. Is this transaction recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security Interest (e.g., cosigner)? X E. Is this document recorded to substitute a trustee under a deed of trust; mortgage, or other similar document? _X_ F. Did this transfer result in the creation of a joint tenancy in which .the seller (transferor) remains as one of the joint tenants? _ X G. Does this transfer return property to the person who created the joint tenancy (original transferor)? H. Is this transfer of property: X 1. to a trust for the benefit of the Grantor _ Grantor's spouse? 2. to a trust revocable by the transferor? X 3. to a trust from which the property reverts to the grantor within 12 years? X I. If this property is subject to a lease, is the remaining lease term 35 years or more including written options? • J. Is this transfer between parent(s) and child(ren)? _ or from grandparent(s) to grandchild(ren)? • K. Is this transaction to rep ace a principal residence by a person 55 years of age or older?. Within the same county? Yes No X • L. Is this transaction to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5? Within the same county? Yes No If you checked yes to J, K or L, you may qualify for a property tax reassessment exclusion, which may result in lower taxes on your property. If you do not file a claim, your'pioperty will be reassessed. Please provide any other information that will help the Assessor to understand the.nature of the transfer. If the conveying document constitutes an exclusion from a change in ownership as defined in section 62 of the Revenue and Taxation Code for any reason other than those listed above, set forth the specific exclusions claimed: Please answer a# questions /n each Seddon, 1f a question does not apply, Indicate with 'N/A. " Sign and date at bottom of secaed page. PART II: OTHER TRANSFER INFORMATION A. Date of transfer if other than recording.date B. Type of transfer (please check appropriate boil: _ Purchase Foreclosure Gift _ Trade or Exchange X Merger, Stock, or Partnership Acquisition _ Contract of'gale - Date of C—ontract _ Inheritance - Date of Death Other (please explain): _ Creation of Lease Assignment of a Lease _ Termination of a Lease _ Sa e/Leaseback _ Date lease began Original term in years (including written options) Remaining term in years (including written options) Monthly Payment Remaining Term C. Was only a partial interest in the property transferred? Yes _X No If yes, Indicate the percentage transferred %. (PCORS B. W PF) ( 11-03) BOE -602-A REV. 6 (8-03) Please answer, to the best of your knowledge, all applicable questions, sign and date. If a question does not apply, indicate with 'N/A." PART III: PURCHASE PRICE AND TERMS OF SALE ' A. CASH DOWN PAYMENT OR value of trade of exchange (excluding dosing conte) Amount S 37,633.828 B. FIRST DEED OF TRUST @ % interest for ` years. Pymts./Mo.=$ (Prin. & Int. only) Amount $ FHA ( Discount Points) _ Fixed rate —Now loan _ Conventional _ Variable rate _ Assumed existing loan balance _ VA ( Discount Points) _ All Inclusive D.T. 0 Wrapped) _ Bank or savings & loan _ Cal -Vet _ Loan carried by seller _ Finance company Balloon payment _ YesNo Due Date Amount $ C. SECOND DEED OF TRUST @ _% interest for _ years. Pymts./Mo.=S (Priv. & Int. only) Amount $ _ Bank or savings 6 loan Fixed rate _ New loan _ Loan carried by sellerVariable rate ^ Assumed existing loan balance Balloon payment Yes _ No Due Date•_ Amount $ D. OTHER FINANCING: Is other financing involved not covered in (b) or (c) above? _ Yes _ No Amount $ Type @ ,% interest for _ years. Pymts./Mo. – $ (Prin. & Int. only) _ .Bank or savings & loan _ Fixed rate _ New loan _ Loan carried by. seller _ Variable rate _ Assumed existing loan balance Balloon payment _ Yes _ No Due Date Amount $ E. WAS AN IMPROVEMENT BOND ASSUMED BY THE BUYER?_ Yes _ No Outstanding Balance: Amount $ F. TOTAL PURCHASE PRICE (or acquisition price, if traded or exchanged, include real estate commission if paid) TOTAL ITEMS A THROUGH E S 37,633,828. G. PROPERTY PURCHASED _ Through a broker — Direct from seller _ From a family member _ Other (please explain) If purchased through a broker, provide broker's name and phone number: Please explain any special terms, seller concessions, or financing and any other information that would help the Assessor understand the purchase price and terms of sale: PART IV: PROPERTY INFORMATION A. TYPE OF PROPERTY TRANSFERRED: _ Single-family residence ` Agricultural Timeshare Multiple -family residence (no. of units: ) Co-op/Own-your-own _ Manufactured home X.' Commercial/Industrial Condominium ^ Unimproved lot _ Other (Description: i.e., timber, mineral, water rights, etc. ) B. FS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? _ Yes X No It yes, enter date of occupancy / 20 or intended occupancy 1120 ' (month) (day) (yearl .. (month) (day) (year) C. IS PERSONAL PROPERTY INCLUDED IN THE PURCHASE PRICE (i.e., furniture, farm equipment, machinery, etc.) (other than a manufactured home subject to local property tax)? _ Yes X No If yes, enter the value of the personal property included in the purchase price $ (Attach itemized list of personal property.) D. IS A MANUFACTURED HOME INCLUDED IN PURCHASE PRICE? ' —Yes ,X No If yes, how much of the purchase price -Is allocated to the manufactured home? $ Is the manufactured home subject to local property tax? _ Yes _X.. No What Is the decal number? E.' DOES THE PROPERTY PRODUCE INCOME? _ Yes X .No If yes, is the Income from: _ Lease/Rent • Contract _ Mineral rights. _ Other (please explain): F. WHAT WAS THE CONDITION OF THE PROPERTY AT THE TIME OF SALE? X Good_ Average Fair Poor Please explain the physical condition of the property and provide any other Information (such as restrictions, etc.) that would assist the Assessor in determining the value of the property: " Land to be used for future development. CERTIMCATION OWNERSHIP TYPE (✓) Pr — I certify that the foregoing is true, correct and complete to the best of my knowledge and belief. P"" Wtmer1 P — Corporation Thls declaration Is binding on each and every co-owner and/or partner. owr LLC g NAME OF NEW O NE C RPORAT O FI E TLE Brian J. iS President & WO SIGNATURE OF ow ER ORP AT O I DATErAy'�' AT -7 /j 7 4ZJ n �/� `Ws - NAME O ENTIT typed or primed) FEDERAL PLOY 10 NUMBER AST OF ISON LLC 1136 S I g 2 -r ADDRESS !typed or printed) TELEPHQNE NUMBER DATE c/o Nationwide Realty Investors,.Ltd. (NOTE: The Assessor may'contact you for additional Information.) ' N a document evidencing a change of ownership is presented to the recorder for recordation without the concurrent filing of a preliminary change of ownership report, the recorder may charge an additional recording fee of twenty dollars ($20). 375 N. Front St., Suite 200 (PCORSB.WPF)(t1-03) Columbus, 011 43215 Plan Check # RIVERSIDE COUNTY COMMUNITY HEALTH AGENCY DEP.A.RTIVIENT OF ENVIRONMENTAL HEALTH FOOD ESTABLISHMENT PLAN APPROVAL NOTICE Project Name Madison Club -Halfway House Address Plans Submitted by Jeff Prevost Date 07/12/06 80955 Ave 52 La Quinta Phone 602-920-7183 Owner Madison club Address Ave 52, La Quinta Phone The plans are now approved subject to the conditions listed below and the attached compliance sheet. Note: This approval is for a small facility which offers 100% pre-packaged foods. Ice, dispensed by gravity - type dispenser, is the only non -packaged food offered by this facility. 1) Provide a grease interceptor sizing or waiver letter from the appropriate agency prior to final inspection. 2) Install FRP in janitor's room to a minimurn height of 8'. 3) Provide an approved water-resistant material behind all sinks. To a minimum of 4' behind all hand wash sinks; to a minimum hei ht of 8' behind all other sinks. 4) Provide an additional 3 linear feet of back-up dry storage units for a total of 28 linear feet. 5) Quarry tile base cove must form a minimum 3/8" radius at floor -wall juncture. 6) Basins of 3 -compartment sink must be large enough to totally submerse largest utensil to be washed in facility. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working daysin advance. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY Debra Johnson Phone (760) 320-1048 I acknowledge the corrections note construction: Signature Company Name rein and as indicated on the plans and agree to incorporate them du Corona Hemet Indio Murrieta Palm Springs Riverside 2275 S. Main St Suite 204 800 S. Sanderson 47-950 Arabia St "A" 38740 Sky Canyon Dr 2500 N. Palm Canyon Dr 4065 County C (951),273-9140 (951) 766-2824 (760) 863-8287 (951) 461-0284 (760) 320.10.18 (951) 35S-517 Fax (951) 520-8319 Fax (951) 766-7874 Fax (760) 863-8303 Fax (951) 461-0245 Fax (760) 320-1470 Fax (951) 356-5 Department Web Site — Nvww.rivcoeh.org 0 RIVERSIDE COUNTY FIRE DEPARTMENT Highway82-675 Indio, . Fax V60) 863- 70 72 Jct Itualy , 20 2006 Craig E. Anthony Pearson Architects, Inc. Fire Chief 74-040 Hwy 111, Ste. 232 Palm Desert, CA 92260 Proudly serving the unincorporated Re: Non -Structural Building Plan Review areas of Riverside LAQ-06-BP-007 / Madison Club — Halfway House County and the Cities of: .Fire Department personnel have reviewed and approved the plans you submitted for the above Banning referenced project. Please be advised the following conditions apply as a part of the conditions for the issuance of a building permit. Beaumont s• 1) The Fire Department is required to set a minimum fire flow for the remodel or construction of all Calimesa commercial buildings using the procedure established in the 2001 CFC. A fire flow of 1500 gpm for a 2 -hour duration at 20 psi residual operating pressure must be available before any combustible Canyon Lake 4. material is placed on the job site. Coachella 2) The required fire flow shall be available from a Super hydrant(s) (6" x 4" x 21/2" x 21/2") located not Desert Hot Springs less than 25' or more than 165' from any portion of the building(s) as measured along approved 4. vehicular travel ways. Indian Wells f 4. 3) Prior to the issuance of a building permit, applicant/developer. shall furnish one blueline copy of the Indio water system plans to the Fire Department for review. ' Plans shall conform to the fire hydrant types, 4' location and spacing, and the system shall meet the fire flow requirements. Plans must be signed Lake Elsinore by a registered Civil Engineer and/or the local water company with the following certification: "I La Quinta certify that the design of the water system is in accordance with the requirements prescribed by the Riverside County Fire Department". Moreno Valley . 4) Install Knox Key Lock box, Model 3200, mounted per recommended standard of the Knox Palm Desert Company. If the building/facility is protected with a fire alarm system or burglar alarm system, the lock boxes will require "tamper" monitoring. Special forms are available from this office for the Perris ordering of the Key Switch. This form must be authorized and signed by this office for the correctly coded system to be purchased. Rancho Mirage 4. San Jacinto4. 5) Install portable fire extinguishers per Title 19, but not less than 2A1 OBC in rating. Contact a certified extinguisher company for proper placement and spacing of equipment. Temecula Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy. Board of Supervisors All questions regarding the meaning of these conditions should be referred to the Fire Department Planning & Engineering staff at (760) 863-8886. Bob Buster, District 1 Sincerely, John Tavaglione, District 2 Tracy Hobday Jeff Stone, Chief Fire Department Planner District 3 Roy Wilson, / District 4 By Marion Ashley, Walter Grandes District s Fire Safety Specialist Cc: City of La Quinta- Building Dept. HAPEMP DaW%U QuteNROJECTSMkA*q PcMA0-0&8P-007.dm EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82.675 Highway 111, 2^d A., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 - JCM Inspections'• 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 pin INSPECTIONS REINFORCED CONCRETE INSPECTION REPORT Date: Project Name: Project No: MC+Son C LIn. w Aotisz, 'l z' Project Address: -_3 City• 453 s-3-70. 1 � C �' �Kl O!1 " k u� �0. Q✓ IBC Title 24 Other: Client: ll Sub -Contractor: S\ G 1+ S ,t'0 Q -QC i General Contractor: Architect: Structural Engi"�eer: (� Lus�c�i.; t!ons�. ��.�s Acc�.; e Q• G•��u�ur� �•n �� ir+q�ik Slump (inches): Supplier: Time Sampled: Mix Design: Time in Mixer (min.): Specified Strength (PSI): Water Added @ Jobsite (gals.): Addmixture: Concrete Temperature (F): Truck #: Ticket #: Ambient Air Temperature (F): Field ID Marking: yleat; o � C �� u Unresolved Iten)s:-J ® None ❑ See Below Location of Sample: &No Samples Taken Description of Work Inspected: o �� ,b� 4 — @uJ I'a(Y\Lk WAS C% NJ -Z" 0 VQAK\,-\ cr_._. carr oaC a r C \Oyylooz& -P Keeir .A-e� -� � P a ®p a� 1S % � 4 n e � Q1 � rt'lh, Ir,rJ ol'a & b n S .) E. G S n o �i�1 on S a I C 1n r c ac� u S1Zc , <G CO -M a S-1. Cx0Ve c o-0 XI Er AZc" V__ 0Ct1C vk)Q.S Se CA.t C 'f i� £' S V � . c) r \ nt ILA t, n M C&D f �' n C'0\\p r S). n V I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability 1 have found this work to comply with the approved plans, specifications _applicable building laws. Final report issued at project completion. Inspector: Jack C. Millin ICC Certificatio N,'r'0842216-80 Contractor's or's Representative: f '/ � - I Copy 1 JCM Inspections� Copy 2 Project Superintendent [fCop�,3 Governing Agency Page of v r 1T z 's t r'" r T' TITLE 24 REPORT Title 24 Report for: Madison Club Halfway House Avenue 54 and Monroe Street La Quinta, CA 92253 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED CT Project Desi g er: ION FOR CONSTR DA BY 0 Report Prepared By: Jason Vander Veen Stueven Engineering ,Consultants 326 Kalmia Street Escondido, CA 92025 (760) 735-8577 Job Number: 0 Date: ey 12/22/2005 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. r EnergyPro 4.0 by EnergySoft Job Number: User Number: 3429 TABLE OF CONTENTS Cover Page Table of Contents Nonresidential Performance Title 24 Forms Form ENV -MM Envelope Mandatory Measures Form MECH-MM Mechanical Mandatory Measures 1 2 3 11 12 EnergyPro 4.0 by EnergySoft Job Number User Number: 3429 PERFORMANCE CERTIFICATE OF COMPLIANCE Part 1 of 3 PERF -1 PROJECT NAME — DATE Madison Club Halfway_House .— _ _ 12/22/2005 PROJECT ADDRESS SI ATUR Avenue 54 and Monroe Street La Quinta CONDITIONED FLOOR AREA CLIMATE ZONE 490 Sq.Ft. 1 15 PRINCIPAL DESIGNER - ENVELOPE _ TELEPHONE Building Permit # DOCUMENTATION AUTHOR TELEPHONE Checked bjy/Date Stueven Engineering Consultants (760) 735-8577 Enforcement Agency Use GENERAL INFORMATION This Certificate of Compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to a Building using the performance compliance approach. The documentation preparer hereby certifies that the documentation Is accurate and complete. DATE OF PLANSBUILDING SI ATUR DATE CONDITIONED FLOOR AREA CLIMATE ZONE 490 Sq.Ft. 1 15 BUILDING TYPE o NONRESIDENTIAL Ej HIGH RISE RESIDENTIAL HOTEL/MOTEL GUEST ROOM PHASE OF CONSTRUCTION ® NEW CONSTRUCTION [:] ADDITION [:] ALTERATION EXISTING + ADDITION STATEMENT OF COMPLIANCE This Certificate of Compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to a Building using the performance compliance approach. The documentation preparer hereby certifies that the documentation Is accurate and complete. DOCUMENTATION AUTHOR SI ATUR DATE Jason Vander Veen---� o The Principal Designer hereby certifys that the proposed b ding design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building as designed meets the energy efficiency requirements contained in sections 110, 116, through 118, and 140, 142, 143 or 149 of Title 24, Part 6. ENV. LTG. MECH. 1. 1 hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its preparation; and that I am licensed in the State of California as a civil engineer, mechanical engineer, or I am a licensed architect. El 2. 1 affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. 3. 1 affirm that I am eligible under Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described as exempt pusuant to Business and Professions Code Sections 5537, 5538, and 6737.1. (These sections of the Business and Professions Code are printed in full in the Nonresidential Manual.) ENVELOPE COMPLIANCE Indicate location on plans of Note Block for Mandatory Measures ENV -1 Required Forms PRINCIPAL ENVELOPE DESIGNER - NAME SIGNATURE LIC. NO. DATE LIGHTING COMPLIANCE Indicate location on plans of Note Block for Mandatory Measures Lighting Compliance Not'ln The Scope Of Thf�SCJbSm-itta — -- Required Forms PRINCIPAL LIGHTING DESIGNER - NAME SIGNATURE LIC. NO. DATE MECHANICAL COMPLIANCE Indicate location on plans of Note Block for Mandatory Measures Required MECH-2, MECH-3 _Forms _M_E_CH-1, — PRINCIPAL MECHANICAL DESIGNER -NAME SIGNATURE — yLIC. NO. DATE 4.0 by EnergySoft User Number: 3429 Job Number: Page:3 of 13 PERFORMANCE CERTIFICATE OF COMPLIANCE Part 2 of 3 PERF -1 ?PROJECT NAME DATE -:1 Madison Club Halfway House 12/22/2005 ANNUAL TDV ENERGY USE SUMMARY kBtu/s ft- r ENERGY COMPONENT Standard Design 13.87 255.57 96.94 0.00 '0.00 0.00 53.61 32.76 452.76 Proposed Design sgft. sgft. sgft. Compliance Margin ,(®_sia�aaro,v�■-a,o�oeea- - WE "S� mr �kk_$? .N tint a3 process) - Space Heating Space Cooling Indoor Fans Heat Rejection Pumps & Misc. Domestic -Hot Water Lighting Receptacle Process0.00 TOTALS: Percent better than Standard: 0.34 13.54 180.27 75.30 76_.13 20.82 0.00 0.00 0.00 0.00 0.00 0.00 53.61 0.00 32.76 0.00: o.00 343.10 109.66 24.2% ( 24.2% excluding BUILDING COMPLIES GENERAL INFORMATION Building Orientation Number of Stories Number of Systems Number of Zones North 0 deg Conditioned Floor Area Unconditioned Floor Area Conditioned Footprint Area Fuel Type 490 sgft. sgft. sgft. 1 0 1 490 3 Natural Gas 20 7.3% Orientation Front Elevation North Left Elevation (East) Rear Elevation South Right Elevation I (west) , ' Total Roof Gross Area sgft. sgft. sgft. sgft. sgft: sgft. Glazing Area Glazing sgft. sgft. sgft. sgft. sqf<. sgft. Ratio 266 24 9.0% 274 20 7.3% 315 60 19.0% 1761 20 11.4% 1,030 124 12.0% 2ao Standard Proposed Lighting Power Density 0:808 wisgff. 0.000 wisgft. Prescriptive Env. Heat Loss 325 Btu/h 178 Btu/h Prescriptive Env. Heat Gain 21;962 Btu/h-F 21,499 Btulh-F . Remarks: Run Initiation Time: 12/22/05 17:52:12 Run Code: 1135302732 EnergyPro 4.0 by EnergySoft User Number: 3429 Job Number: Page:4 of 13 PERFORMANCE CERTIFICATE OF COMPLIANCE Part 3 of 3 PERF -1 [PROJECT NAME I Madison Club Halfway House DATE 12/22/2005 ZONE INFORMATION System Name Floor Inst. Area LPD Zone Name Occupancy Type (sqft.) (W/sf)1 Ctrl. Credits (W/sf)2 Allowed LPD Proc. Loads (W/Sq Area Tailored (W/S3 (W/S4 HP -1 Kitchen Kitchen, Food Preparation 90 0.00 Utility All Others 60 0.00 Restroom Corridor/Restrooni/Support 340 0.00 Notes: 1. See LTG -2-C 2. See LTG -4-C 3. See LTG -5-C 4. See LTG -G -C (items marked with asterisk, see LTG -2 -C by others) (by others) Items above. require special documentation EXCEPTIONAL CONDITIONS COMPLIANCE CHECKLIST The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Not Valid for permit applications submitted on or after 01/23/06 because Energy Budget is based on SEER 10. The exceptional features listed in this performance approach application have specifically been reviewed. Adequate written justification and documentation for their use have been provided by the applicant. or 4.0 by EnergySoft User Number: 3429 Job Number: Page:5 of 13 CERTIFICATE OF COMPLIANCE ENV -1-C PROJECT NAME DATE L_ Madison Club Halfway House 12/22/2005 OPAQUE SURFACES # i Surface Type_ Area U -Fac. Insulation Cay. Cont. Act. Azm. Tilt Cond: Status Joint Appendix IV Reference Location / Comments 1 Roof 90 0.032 •R-30 R-0.0 0 0 New 01-A17 Kitchen 2 Wall ' 64 0.081 None R-13.0 0 90 New _ _ 12-A9 — Kitchen 3 Wall 68 0.102 R-1 -Q- 90 90ew 90 09 A3 Kitchen 4 Door 40 0.500 None R-0.0 90 90 New 28-A4 Kitchen 5 Roof 60 0.032 R-30 R-0.01 0 0 1 New 01-A17 Utility 6 Wall 28 0.102 R-13 R-0.0 270 90 New 09-A3 Utility _- 7 Door 40 0.500. None R-0.0 270 90 New 28-A4 utility 8 lWall 81 0.081 None R-13.0 90 90 New 12-A9 Utili 9 Roof 90 0.032 R-30 R-0.0 0 0 New 01-A17 Restroom 10 Wall 177 0.102 R-13 R-0.0 0 90 New 09-A3 Restroom ,11 Wall 651 0.081 None R-13.0 90 1 90 New 12-A9 Restroom 12 Wall 255 0.081 None R-13.0 180 90 New 112-A9 Restroom 13 Wall 88 0.081 None R-13.0 270 90 New 12-A9 Restroom R IFENESTRATION SURFACES I More than or equal to 10,000 sq.ft. of site -built fenestration area must include a label certificate either issued by NFRC or provide a CEC Default Label Certificate using the default 1.1 -factors fmm St2nr1nrrtc T2hlp 11Rr12nrt R r:prtifi to eh2ll hp filar) in the mntmntnee nmiprl nffirp rLirinn mm,tn,Minn 2nd in the h„itriinn m2n2nare nfTro 2earrnnetn,rtinn # Tye Area U -Fac? SHGC2 Act. Azm. Cond. Stat. Glazing Tye Location/ Comments 1 Window Front North 12 0.790 116-A 0.70 116-8 0 New Double Metal Clear Kitchen 2 Window Front North 12 0.790 116-A 0.70 116-B 0 New Double Metal Clear Restroom 3 Window Left East 20 0.790 116-A 0.70 116-8 90 New Double Metal Clear Restroom 4 Window Rear South 60 0.790 116-A 0.70 116-B . 180 New Double Metal Clear Restroom 5 Window Right est 20 0.790 116-A 0.70 116-8 270 New Double Metal Clear Restroom (1) U -factor Type: 116-A Default Table from Standards, Table NI -1 Default Table from the ACM Manual Appendix, NFRC Labeled value. (2) SHGC Type: 116-B Default Table from Standards, COG Center of Glass, NFRC Labeled Value EXTERIOR SHADING # Exterior Shade Type SHGC Window Overhang Left Fin Hgt. Wd. Len. Hat. LExt.RExt. Dist. Len. H t. Right Fin Dist. Len. Hot. 1 None 0.76 2 None 0.76 3 None 0.76 _ 4 None 0.76 _ 5 None 0.76 ^— MINIMUM SKYLIGHT AREA FOR LARGE ENCLOSED SPACES The proposed building contains an enclosed space with floor area greater than 25,000 sq.ft, a ceiling height greater than 15 feet and a LPD for general lighting of at least 0.5 Wlsq.ft. If this box Is checked, ENV4-C must be filled out when submitting under the Prescriptive Compliance Approach. I EnergyPro 4.0 by EnergySoft User Number: 3429 Job Number: r Page: 6 of 13 1 CERTIFICATE OF COMPLIANCE MECH-1-C PROJECT NAME DATE Madison Club Halfwav House 1 12/22/2005 ueslgner: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems to be tested in parentheses. The NJ number designates the Section in the Appendix of the Nonresidential ACM Manual that describes the test. Also indicate the person responsible for performing the tests (i.e. the installing contractor, design professional or an agent selected by the owner). Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Building Departments: SYSTEM ACCEPTANCE. Before an occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. In addition a Certificate of Acceptance, MECH-I-A Form shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requiements of Section 10-103(b) and Title 24 Part 6. STATEMENT OF COMPLIANCE ❑ MECH-2-A: Ventilation System Acceptance Document -Variable Air Volume Systems Outdoor Air Acceptance -Constant Air Volume Systems Outdoor Air Acceptance Equipment requiring acceptance testing_ ❑ MECH-3-A: Packaged HVAC Systems Acceptance Document Equipment requiring acceptance testing_ ❑ MECH-4-A: Air Distribution Acceptance Document Equipment requiring acceptance testing ❑ MECH-5-A: Air -Side Economizer Acceptance Document Equipment requiring acceptance testing ❑ MECH-6-A: Demand Control Ventilation Acceptance Document Equipment requiring acceptance testing ❑ MECH-7-A: Supply Fan Variable Flow Control Acceptance Document Equipment requiring acceptance testing ❑ MECH-8-A: -Hydronic System Control Acceptance Document -Variable Flow Controls -Automatic Isolation Con-trols -Water-loop Heat Pump Controls -Variable Frequency Controls Equipment requiring acceptance testing EnergyPro 4.0 by EnergySoft User Number: 3429 Job Number: Pagel of 13 In JAIR'SYSTEM REQUIREMENTS Part 1 of 2 MECH-2-C (PROJECT NAME DATE I Madison Club Halfway House 12/22/2005 SYSTEM FEATURES ITEM OR SYSTEM TAG(S) Number of Systems MANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency Heat Pump Thermostat Furnace Controls Natural Ventilation Minimum Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Insulation PRESCRIPTIVE MEASURES Calculated Heating Capacity x 1.43 2 Proposed Heating Capacity 2 Calculated Sensible Cooling Capacity x 1.212 Proposed Sensible Cooling Capacity 2 Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heating Air Supply Reset Cooling Air Supply Reset Duct Sealing for Prescriptive Compliance T-24 Section AIR SYSTEMS, Central or Single Zone HP -1 1 Reference on Plans or Specification 1 112(a) 7.60 HSPF 112(aa) 13.0 SEER / 11.3 EER 112(b) Yes 112(c), 115(a) n/a 121(b) Yes 121(b) 74 cfm 121 c No 121(c) No 121( ), 122(e) Programmable Switch — 122(e) Heating & Cooling Required 122 Auto 122(8) n/a _ 123 124 R-8.0 144 a & b n/a 144 a&b 15btuh 144 a & b n/a 144.(a & b 17,005 btuh 144 c Constant Volume 144 (c) 144 c Yes 144 d No 144(e) No Economizer — 144 (f) Constant Temp 144 (f) Constant Temp 144 (k) _ No _ 1: For each central and single zone air systems (or group of similar units) fill in the reference to sheet number and/or specification section and paragraph number where the required features are documented. If a requirement is not applicable, put "N/A" in the column. 2: Not required for hydronic heating and cooling. Either enter a value here or put in reference of plans and specificatons per footnote 1. 3: Enter Yes if System is: Constant Volume, Single Zone; Serves < 5,000 sgft; Has > 25% duct in unconditioned space. Duct sealing is required for Prescriptive Compliance. see PERF -1 for performance method duct sealing requirements. I% -.I III11IaUV1I 111116. IL/LLIVV II.VL. IL ul1 VVYG. I IVVVVGr VL EnergyPro 4.0 by EnergySoft User Number: 3429 Job Number: Page:8 of 13 MECHANICAL VENTILATION MECH-3-C PROJECT NAME _ DATE - Madison Club Halfway House _ _12/22/2005 ) PRESCRIPTIVE7REHEA(TMECHANICAL LIMITATION (Sec 144d)) VENTILATION Section 121 b 2 AREA BASIS OCCUPANCY BASIS VAV MINIMUM A 'B C D E F G H I J K L M N ZONE/SYSTEM n D°, T� G p 3 a dD 0 � 1 T -n 3 0 WK 3 X D N n y -n 3 m 3 �� tD 0 �9 n 0, T 7 3 m�5 X C 0 V -n W 3 G3A 1 X G %i °, G D 0 T r. y 3 D 7 �0 ° TNG 3'C H " _. �X y 0 -P A M w3 d O L X Ci rn �. T? �� 0 3 3 3 —• y D Kitchen 90 0.15 14 14 14 Utility 60 0.15 9 9 9 Restroom 340 0.15 51 51 51 HP -1 Total 74 74 Q Minimum ve tilation rate per Section 121 Table 121-6 E Based on fixed seat or the greater of the expected number of occupants and 50% of the CBC occupant load for egress purposes for spaces without fixed sealing__ _, H Required Ventilation Air (REO'D V.A.) is the larger of the ventilation rates calculated on and AREA or OCCUPANCY. BASIS (column D or I _ Must be greater than or equal to H. or use Transfer Air (column N) to make up the difference. J _ Design fan supply cfm (Fan CFM) x 30%; or K Condition area (fl. sq,) x 04 cfm/ft. sq.: or L Maximum of Columns H, J, K, or 300 cfm M This must be less than or equal to Column L and greater that or equal to the sum of Columns+ N_�___ _H N Transfer air must be provided where the Required Ventilation Air (column H) is greater than the Design Minimum Air (column M). Where required, transfer air must be greater than or equal t0 the difference between the Required Ventilation Air (column H) and the Design Minimum Air (column M), column H - M. L EnergyPro 4.0 by EnergySoff _ - User Number: 3429 Job Number: Page: 9 of 13 I MECHANICAL EQUIPMENT DETAILS Part 1 of 2 MECH-5-C IPROJECT NAME Madison Club Halfway House FAN oATe12/22/2005 CHILLER AND TOWER SUMMARY BHP Motor Eff. --j Efficiency - I Tons PUMPS Motor Eff. i — Equipment Name Equipment Type Qty. Tot. Qty GPM BHP Motor Eff. Drive Eff. Pump Control 1301LER SUMMARY CENTRAL SYSTEM RATINGS HEATING COOLING Aux. Condition System Name S stem Type Q Output kW Eff. Output Efficiency Status Economizer Type Carrier 25HBR3-30 Split DX 1 24 0.0 7.60 HSPF 26,40013.0 SEER/ 11.3 EER New No Economizer System Name Fan Type__ Carrier 25HBR3-30 Constant Volume SUPPLY FAN RET1RN FAN Motor Location CFM BHP Motor Eff. Drive Eff. CFM BHP Motor Eff. Drive Eff. Blow -Through 1,000 0.33 64.0% 100.0% none EnergyPro 4.0 by EnergySoft - - - User Number: 3429 _ _ --�— Job Number: - - - ----- - -_ Page: 10 of 13 ENVELOPE MANDATORY MEASURES ENV -MM PROJECT NAME DATE Madison Club Haftav House 12/22/2005 DESCRIPTION _ Designer Enforcement § 118(a) Installed Insulating Material shall have been certified by the manufacturer to comply with the California Quality Standards for insulating material, Title 20, Chapter 4, Article 3. 0 § 118(c) All Insulating Materials shall be Installed in compliance with the flame spread rating and smoke density requirements of Sections 2602 and 707 of Title 24, Part 2. § 117(a) All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked, gasketed, weatherstrlpped or otherwise sealed. ❑ § 116(b) Site Constructed Doors, Windows and Skylights shall be caulked between the unit and the building, and shall be weatherstripped (except for unframed glass doors and fire doors). X❑ § 116(a)1 Manufactured Doors and Windows installed shall have air infiltration rates not exceeding those shown in Table Number' 1-E. of the Standards. Manufactured fenestration products must be labeled for U -value according to NFRC procedures. §118(e) Demising Walls In Nonresidential Buildings: The opaque portions of framed demising walls in nonresidential buildings shall have Insulation with an installed R -value of no less than R-11 between framing members. . 1 EnergyPro By EnergySoft User Number: User Job Number: Page: 11 of 13 MECHANICAL MANDATORY MEASURES Part 1 of 2 MECH-MM PROJECT NAME DATE Madison Club Halfwav House 1 12/22/2005 DESCRIPTION Designer Enforcement Equipment and Systems Efficiencies §111 Any appliance for which there is a California standard established in the Appliance Efficiency Regulations will comply with the applicable standard. § 115(a) Fan type central furnaces shall not have a pilot light. § 123 Piping, except that conveying fluids at temperatures between 60 and 105 degrees Fahrenheit, or within HVAC equipment, shall be insulated in accordance with Standards Section 123. RX § 124 Air handling duct systems shall be installed and insulated in compliance with Sections 601, 603 and 604 of the Uniform Mechanical Code. Controls - § 122(e) Each space conditioning system shall be installed with one of the following: § 122(e)1A Each space conditioning system serving building types such as offices and manufacturing facilities (and all others not explicitly exempt from the requirements of Section 112 (d)) shall be installed with an automatic time switch with an accessible manual override that allows operation of the system during off -hours for up to 4 hours. The time switch shall be capable of programming different schedules for weekdays and weekends and have program backup capabilities that prevent the loss of the device's program and time setting for at least 10 hours if power is interrupted; or F] § 122(e)1 B An occupancy sensor to control the operating period of the system; or § 122(e)1C A 4 -hour timer that can be manually operated to control the operating period of the system. § 122(e)2 Each space conditioning system shall be installed with controls that temporarily restart and temporarily operate the system as required to maintain a setback heating and/or a setup cooling thermostat setpoint. § 122(8) Each space conditioning system serving multiple zones with a combined conditioned floor area more than 25,000 square feet shall be provided with isolation zones. Each zone: shall not exceed 25,000 square feet; shall be provided with isolation devices, such as valves or dampers, that allow the supply of heating or cooling to be setback or shut off independently of other isolation areas; and shall be controlled by a time control device as described above. ® § 122(a&b) Each space conditioning system shall be controlled by an individual thermostat that responds to temperature within the zone. Where used to control heating, the control shall be adjustable down to 55 degrees F or lower. For cooling, the control shall be adjustable up to 85 degrees F or higher. Where used for both heating and cooling, the control shall be capable of providing a deadband of at least 5 degrees F within which the supply of heating and cooling is shut off or reduced to a minimum. X❑ § 122(c) Thermostats shall have numeric setpoints in degrees Fahrenheit (F) and adjustable setpoint stops accessible only to authorized personnel. F§ 112(b) Heat pumps shall be installed with controls to prevent electric resistance supplementary heater operation when the heating load can be met by the heat pump alone. EnergyPro By EnergySoft User Number: User Job Number: Page: 12 of 13 MECHANICAL MANDATORY MEASURES Part 2 of 2 MECH-MM i PROJECT NAME Madison Club Halfway House DATE -1__ 12%22/2005 Description Designer Enforcement Ventilation Q§ 121(e) Controls shall be provided to allow outside air dampers or devices to be operated at the ventilation rates as specified on these plans. § 122(f) Gravity or automatic dampers interlocked and closed on fan shutdown shall be provided on the outside air Intakes and discharges of all space conditioning and exhaust systems. § 122(f) All gravity ventilating systems shall be provided with automatic or readily accessible manually operated dampers in all openings to the outside, except for combustion air openings. § 121(f)1 Air Balancing: The system shall be balanced In accordance with the Nat lonal Environmental Balancing Bureau (NEBB) Procedural Standards (1983), or Associated Air Balance Council (AABC) National Standards (1989); or § 121(f)2 Outside Air Certification: The system shall provide the minimum outside air as shown on the mechanical drawings, and shall be measured and certified by the Installing licensed C-20 mechanical contractor and certified by (1) the design mechanical engineer, (2) the Installing licenced C-20 mechanical contractor, or (3) the person with overall responsibility for the design of the ventilation system; or § 121(f)3 Outside Air Measurement: The system shall be equipped with a calibrated local or remote device capable of measuring the quantity of outside air on a continuous basis and displaying that quantity on a readily accessible display divice; or § 121(f)4 Another method approved by the Commission. Service Water Heating Systems Q§ 113(b)2 If a circulating hot water system Is Installed, It shall have a control capable of automatically turning off the circulating pump(s) when hot water Is not required. 571 § 113(b)3B Lavatories In restrooms of public facilities shall be equipped with controls to limit the outlet temperature to 110 degrees F. a§ 113(b)3C Lavatories in restrooms of public facilities shall be equipped with one of the following: Outlet devices that limit the flow of hot water to a maximum of 0.5 gallons per minute. Foot actuated control valves, and outlet devices that limit the flow of hot water to a maximum of 0.75 gallons per minute. Proximity sensor actuated control valves, and outlet devices that limit the flow of hot water to a maximum of 0.75 gallons per minute. Self-closing valves, and outlet devices that limit the flow of hot water to a maximum of 2.5 gallons per minute, and 0.25 gallons/cycle (circulating system). Self-closing valves, and outlet devices that limit the flow of hot water to a maximum of 2.5 gallons per minute, and 0.50 gallonsicycle (non -circulating system). Self-closing valves, and outlet devices that limit the flow of hot water to a maximum of 2.5 gallons per minute, and 0.75 gallons/cycle (foot switches and proximity sensor controls). _- EnergyPro__ By EnergySoft -____ User Number User ,-- Job Number: __ _ Page: 13 of 13 J