NCC230898_FRO Submitted_20230331

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may initiate any land -disturbing activity on one or more acres as covered by the Wake
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
NUR, 11 (AROI INA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1. Project Name.
Willow Landing Lot 67
2. Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street 1417 Willow Landing Way Latitude -78.694 Longitude 35.579
3. Approximate date land -disturbing activity will commence: 3/13/2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 0.621
A
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Jimmy Gaskins E-mail Address [e-mail]
Telephone [phone] Cell # 919-868-5391 Fax # N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
KB Home Raleigh -Durham, Inc. 919-768-7988
N/A
Name(s)
Telephone Fax or E-mail address
4506 S. Miami Blvd., Ste. 100
Same
Current Mailing Address
Current Street Address
Durham NC 27703
City State Zip
City State Zip
8. Deed Book No. 019284 Page No.
00831-00835 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially
responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
KB Home Raleigh -Durham, Inc.
[e-mail]
Name
E-mail Address
4506 S. Miami Blvd., Ste. 100
Same
Current Mailing Address
Current Street Address
Durham NC 27703
City State Zip
City State Zip
Telephone [phone]
Fax Number N/A

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Doug Schwartz [e-mail]
Name E-mail Address
1405 Willow Landing Way Same
Current Mailing Address Current Street Address
Willow Spring NC 27592
City State Zip City State Zip
Telephone [phone] Fax Number N/A
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Doug Schwartz
Type or print name
��e-;�gje5_
Signature
Division President, KB Home Raleigh -Durham, Inc.
Title or Authority
3-Z1, Z'S
Date
\S0\\ou1 , a Notary Public of the County of 0\ fyc.�-o�
State of North Carolina, hereby certify that ���, c� '�)C_V W c.,�A-L appeared
personally before me this day and being duly sworn acknowf dged that the above form was executed by him.
5�
Witness my hand and notarial seal, this d day ofca
ERIN N POLLOCK � l
NOTARY PUBLIC
Johnston County Notary
North Carolina
Se by Commission Expires June 17, 2024 My commission expires 7)y\N9- �1

BKO19284PGO0831
Excise Tax: $3,135,00
WAKE COUNTY, NC
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
03-15-2023 AT 13:56:02
STATE OF NC REAL ESTATE
EXCISE TAX: $3,135.00
BOOK: 019284 PAGE: 00831 - 00835
Parcel Identifier No. Lot 7:0498875, Lot 8: 0498876, Lot 9: 0498877, Lot 10: 0498878, Lot 1 1:
0498879, Lot 12: 0498880, Lot 13: 0498881, Lot 14: 0498882, Lot 15: 0498883, Lot 16: 0498884,
Lot 61:'0498929, Lot 62: 0498930, Lot 63: 0498931, Lot 64: 0498939 and Lot 67: 0498942
This instrument was prepared by: Bagwell Holt Smith P.A., I 1 I Cloister Court, Ste. 200, Chapel
Hill, NC 27514
When recorded, return to: Grantee
GRANT DEC, D WITH REPURCHASE RIGHT
FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby
acknowledged, Willow Landing - Willow Spring, L.P., a Delaware limited partnership
("Grantor"), with a mailing address of 23975 Park Sorrento, Suite 220, Calabasas, CA 91302, has
GRANTED, SOLD and CONVEYED, and by these presents does GRANT, SELL and CONVEY
to KB HOME Raleigh -Durham Inc., a Delaware corporation ("Grantee"), with it mailing address
of 4506 S. Miami Blvd., # 100, Durham, NC 27703, that certain real property ("Property") in the
Middle Creek Township, Wake County, Slate of North Carolina, which is more particularly
described on Exhibit A attached hereto and incorporated herein by this reference, together with all
improvements located thereon and all rights, privileges, easements, tenements, and appurtenances
pertaining thereto.
This conveyance is made subject to all general and special real property takes and
assessments, and Covenants, conditions, restrictions, rights of way, rights, interests, easements and
reservations of record or otherwise known to Grantee, and further sttb,iect to the release of Grantor
included below find Grantor's repurchase right as set forth-and.linlited_-in Scctign.23(c) (Owner's
Right to Repurchase Lots) of that certain Option and Development Agreement between Grantor
and Grantee, dated September 15, 2022, for reference purposes (together, the "Permitted
Exceptions"). Said repurchase right is a continuing right and shall only be extinguished upon
Grantor's recording of a quit claim deed relinquishing such repurchase right with respect to the
Property or an applicable portion thereof in the official records of Wake County, North Carolina,
provided, however, that such repurchase right shall automatically terminate with respect to tiny
single lot within the Property upon (i) the closing of the sale of such lot with a substantially
submitted electronically by "Bagwell Holt smith P.A."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the wake county Register of Deeds.

BKO19284PGO0832
completed home thereon to a member of the homebuying public, or (ii) the conveyance of any
such lot to a homeowner's association that includes or has a right to annex the Property.
All or a portion of the Property does not include the primary residence of Grantor,
TO HAVE AND TO HOLD the above described premises, together with all and singular
the rights and appurtenances thereto in any wise belonging, onto Grantee, its successors, legal
representatives and assigns forever; and Grantor does hereby bind itself and its legal
representatives to WARRANT and FOREVER DEFEND, all and singular the said premises onto
Grantee, its successors, legal representatives and assigns, against every person whomsoever
lawfi►ily claiming or to claim the same or any part thereof by, through or under Grantor but not
otherwise, subject to the Permitted Exceptions.
[SIGNATURE PAGE FOLLOWS]

BKO19284PGO0833
IN WITNESS WHEREOF, Grantor has caused this Grant Deed with Repurchase Right to be
executed as of the IS�' day of March, 2023.
Willow Landing-- Willow Spring, L.P.,
a Delaware limited partnership
By: Cal Hearthstone PBLO GP, LLC,
A Delaware limited liability company,
General Partner
By: Cal Hearthstone Public Builder Lot Option, LLC,
a Delaware limited liability company,
Sole Member
By: Hearthstone Professionals — CS, L.P.,
a Delaware limited Partnership,
Member Manager
By:
Steven C. Paralh
Authorized Person

BKO19284PGO0834
ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the Individual
who signed the document to which this certificate is attached, and not the truthfulness, accuracy,
or validity of that document.
State of California )
County of Les
On ,2�, ( � 'Za'� , before me, KAW-Cy�rS 464,N OAc tL _. ,
(insert nnmc or notary)
Notary Public, personally appeared C- 4)0-
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same
in his/her/their authorized capacity(ics), and that by his/her/their signatures) oil the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
1 certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing }paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
.�.,�—.
KAREN S. HORNBACK
Notary Public • California
Ventura County
Commission N 24f3766
My Comm, Expires Aug 24, 2026

BKO19284PGO0835
Exhibit A -- Legal Description
Being all of Lots 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 61, 62, 63, 64 and 67 as shown on Plat entitled
"Willow Landing" of record in Book of Maps 2022 Pages 1369 through 1372, inclusive, Wake
County Regishy.