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Home My WebLink About2023-179 UBCA Inc. Certified Payroll12/1/22, 3:12 PM eCPR Form Application https://efiling.dir.ca.gov/eCPR/pages/eCPROnlineForm.jsp 1/1 Your payroll submission request has been processed. Please review the results of your submission. Should you have any questions please contact the eCPR unit at publicworks@dir.ca.gov. Contractor Name: UBCA, INC. Contractor Address: 33175 TEMECULA PKWY STE A #747 TEMECULA CA 92592 Awarding Body: CITY OF LAKE ELSINORE Project ID: 441790 Contract With: CITY OF LAKE ELSINORE Week Ending Date: 2022-11-20 Payroll Number: 1 Amendment Number: 0 6 employee payroll record(s) processed Your Transaction ID is: 15725391 Print this Page View your submission Submit another set of payroll records eCPR Online Confirmation Contractor Name:License Type:License NumberContractor PWCR: Address:Contractor Email: Insurance Number: FEIN: UBCA, INC. 33175 TEMECULA PKWY STE A #747, TEMECULA, CA 92592 1000059590 825470088 CSLB 920943 UNIQUEBUILDERSOFCA@GMAIL.COM CST5016472 Awarding Body:DIR Project ID:Project Name: Contract With:Address:County: CITY OF LAKE ELSINORE CITY OF LAKE ELSINORE 441790 RIVERSIDE DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY 500 DIAMOND DRIVE, LAKE ELSINORE, CA 92530 Payroll #:1 -0 Ctr Payroll #:4 Week Ending:11/20/2022 Statement of Non-Performance?Final payroll for this project? Employee:102879991 DANIEL GONZALEZ 1420 GALERIA CT, PERRIS, CA, 92570DANIEL GONZALEZ 1420 GALERIA CT, PERRIS, CA, 92570 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 8.00 8.00 8.00 8.00 8.00 0.00 0.00 40.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 682.15 Public Works Certified Payroll Reporting Form Certification under penalty of perjury: Public Works Certified Payroll Reporting Form 12/01/2022 - Page 1 "I, KERI CARTER, the undersigned, am the PRESIDENT (position in business) with the authority to act for and on behalf of UBCA, INC (name of business and/or contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2022-11-20 are the originals or true, full, and correct copies of the originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2022-12-01." Employee:611553164 MARIO IBARRA 2151 WILDFLOWER AVE., HEMET, CA, 92545MARIO IBARRA 2151 WILDFLOWER AVE., HEMET, CA, 92545 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 0.00 8.00 0.008.00 0.00 0.00 0.00 16.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 179.53 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 12/01/2022 - Page 2 Contractor Name:Project Name:Week Ending:11/20/2022 0-1Payroll Number:UBCA, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:604352882 JOSEPSH KREEGER 32200 CORTE MATARO, TEMECULA, CA, 92592JOSEPSH KREEGER 32200 CORTE MATARO, TEMECULA, CA, 92592 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 8.00 8.00 8.008.00 8.00 0.00 0.00 40.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 937.26 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 12/01/2022 - Page 3 Contractor Name:Project Name:Week Ending:11/20/2022 0-1Payroll Number:UBCA, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:623729983 LEOBARDO MARTINEZ 1188 S. GILBERT ST., HEMET, CA, 92543LEOBARDO MARTINEZ 1188 S. GILBERT ST., HEMET, CA, 92543 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 8.00 8.00 8.008.00 8.00 0.00 0.00 40.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 897.57 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 12/01/2022 - Page 4 Contractor Name:Project Name:Week Ending:11/20/2022 0-1Payroll Number:UBCA, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:618801263 BRIAN MERRILL 7316 RAINBOW HEIGHTS RD, FALLBROOK, CA, 92028BRIAN MERRILL 7316 RAINBOW HEIGHTS RD, FALLBROOK, CA, 92028 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 8.00 8.00 8.008.00 8.00 0.00 0.00 40.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 713.75 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 12/01/2022 - Page 5 Contractor Name:Project Name:Week Ending:11/20/2022 0-1Payroll Number:UBCA, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:611969251 ORLANDO SANTIAGO P.O. BOX 1011, PERRIS, CA, 92572ORLANDO SANTIAGO P.O. BOX 1011, PERRIS, CA, 92572 SSN: Mon 11/14 Tue 11/15 Wed 11/16 Thu 11/17 Fri 11/18 Sat 11/19 Sun 11/20 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S LABORER 8.00 8.00 8.008.00 8.00 0.00 0.00 40.00 64.49 0.00 0.00 0.00 0.00 0.70 65.190.00 NOTE:Travel & Subsistence 0.00 Total Deductions 801.82 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 12/01/2022 - Page 6 Contractor Name:Project Name:Week Ending:11/20/2022 0-1Payroll Number:UBCA, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Contractor Name:License Type:License NumberContractor PWCR: Address:Contractor Email: Insurance Number: FEIN: GENESIS GLASS INSTALLATIONS, INC. 265 E. MILL ST SUITE A, SAN BERNARDINO, CA 92408 1000021562 261978648 CSLB 919766 GENESISGLASS2005@GMAIL.COM FLA006260-05 Awarding Body:DIR Project ID:Project Name: Contract With:Address:County: CITY OF LAKE ELSINORE UNIQUE BUILDERS 441790 RIVERSIDE DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY 500 DIAMOND DRIVE, LAKE ELSINORE, CA 92530 Payroll #:5 -0 Ctr Payroll #:5 Week Ending:04/23/2023 Statement of Non-Performance?Final payroll for this project? Public Works Certified Payroll Reporting Form Certification under penalty of perjury: Public Works Certified Payroll Reporting Form 04/24/2023 - Page 1 "I, PATRICIA MEDINA, the undersigned, am the OFFICE MANAGER (position in business) with the authority to act for and on behalf of GENESIS GLASS INSTALLATIONS, INC (name of business and/or contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2023-04-23 are the originals or true, full, and correct copies of the originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2023-04-24." Contractor Name:License Type:License NumberContractor PWCR: Address:Contractor Email: Insurance Number: FEIN: GENESIS GLASS INSTALLATIONS, INC. 265 E. MILL ST SUITE A, SAN BERNARDINO, CA 92408 1000021562 261978648 CSLB 919766 GENESISGLASS2005@GMAIL.COM FLA006260-05 Awarding Body:DIR Project ID:Project Name: Contract With:Address:County: CITY OF LAKE ELSINORE UNIQUE BUILDERS 441790 RIVERSIDE DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY 500 DIAMOND DRIVE, LAKE ELSINORE, CA 92530 Payroll #:4 -0 Ctr Payroll #:4 Week Ending:04/16/2023 Statement of Non-Performance?Final payroll for this project? Employee:608760532 ADRIAN MONTOYA DURAN 780 E 9TH ST SPC #3, SAN BERNARDINO, CA, 92410ADRIAN MONTOYA DURAN 780 E 9TH ST SPC #3, SAN BERNARDINO, CA, 92410 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER JOURNEYMAN 4.00 5.00 5.00 0.00 0.00 0.00 0.00 14.00 53.00 24.08 0.00 8.25 14.85 0.77 77.850.98 NOTE:Travel & Subsistence 0.00 Total Deductions 356.03 Public Works Certified Payroll Reporting Form Certification under penalty of perjury: Public Works Certified Payroll Reporting Form 04/24/2023 - Page 1 "I, PATRICIA MEDINA, the undersigned, am the OFFICE MANAGER (position in business) with the authority to act for and on behalf of GENESIS GLASS INSTALLATIONS, INC (name of business and/or contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2023-04-16 are the originals or true, full, and correct copies of the originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2023-04-24." Employee:619850076 EBODIO BAUTISTA TORRES 760 E 9TH ST SPC 124, SAN BERNARDINO, CA, 92410EBODIO BAUTISTA TORRES 760 E 9TH ST SPC 124, SAN BERNARDINO, CA, 92410 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER JOURNEYMAN 4.00 0.00 0.000.00 0.00 0.00 0.00 4.00 53.00 24.08 0.00 8.25 14.85 0.77 77.850.98 NOTE:Travel & Subsistence 0.00 Total Deductions 151.25 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 04/24/2023 - Page 2 Contractor Name:Project Name:Week Ending:04/16/2023 0-4Payroll Number:GENESIS GLASS INSTALLATIONS, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:618751043 FELIX MURILLO 2166 E AMANDA ST, SAN BERNARDINO, CA, 92410FELIX MURILLO 2166 E AMANDA ST, SAN BERNARDINO, CA, 92410 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER JOURNEYMAN 4.00 0.00 0.000.00 0.00 0.00 0.00 4.00 53.00 24.08 0.00 8.25 14.85 0.77 77.850.98 NOTE:Travel & Subsistence 0.00 Total Deductions 153.25 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 04/24/2023 - Page 3 Contractor Name:Project Name:Week Ending:04/16/2023 0-4Payroll Number:GENESIS GLASS INSTALLATIONS, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:622138981 ZECHARIAH DIAZ 20866 UNION STREET, WILDOMAR, CA, 92595ZECHARIAH DIAZ 20866 UNION STREET, WILDOMAR, CA, 92595 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER APPRENTICE 6.00 5.00 0.000.00 0.00 0.00 0.00 11.00 22.26 15.47 0.00 8.25 6.24 0.77 38.500.98 NOTE:Travel & Subsistence 0.00 Total Deductions 57.19 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 04/24/2023 - Page 4 Contractor Name:Project Name:Week Ending:04/16/2023 0-4Payroll Number:GENESIS GLASS INSTALLATIONS, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:629087453 RONY-SEBASTIAN ULUAN SANTIAGO 760 E 9TH ST SPC 12, SAN BERNARDINO, CA, 92410RONY-SEBASTIAN ULUAN SANTIAGO 760 E 9TH ST SPC 12, SAN BERNARDINO, CA, 92410 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER 0.00 0.00 0.005.00 0.00 0.00 0.00 5.00 53.00 24.08 0.00 8.25 14.85 0.77 77.850.98 NOTE:Travel & Subsistence 0.00 Total Deductions 483.72 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 04/24/2023 - Page 5 Contractor Name:Project Name:Week Ending:04/16/2023 0-4Payroll Number:GENESIS GLASS INSTALLATIONS, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY Employee:093694426 JOSE BARRAGAN 615 W VAN KOEVERING ST, RIALTO, CA, 92376JOSE BARRAGAN 615 W VAN KOEVERING ST, RIALTO, CA, 92376 SSN: Mon 04/10 Tue 04/11 Wed 04/12 Thu 04/13 Fri 04/14 Sat 04/15 Sun 04/16 Total Hours Base Hourly Total Fringe Vac/ Holiday Health & Welf.Pension Training Total Hourly RateOther S GLAZIER JOURNEYMAN 2.00 2.00 0.000.00 0.00 0.00 0.00 4.00 53.00 24.08 0.00 8.25 14.85 0.77 77.850.98 NOTE:Travel & Subsistence 0.00 Total Deductions 144.85 Public Works Certified Payroll Reporting Form Public Works Certified Payroll Reporting Form 04/24/2023 - Page 6 Contractor Name:Project Name:Week Ending:04/16/2023 0-4Payroll Number:GENESIS GLASS INSTALLATIONS, INC.DIAMOND CLUB KITCHEN & BEVERAGE SERVICES AREA ADA ACCESSIBILITY