HomeMy WebLinkAbout1000012670_20250578090_2025-09-14_PRRUN3434141 (4) IState of California
Uepartmentof Public Works Electronic Payroll Reporting Form
FT4x M. Industrial Relations
PWCR# 1000012670 DIR Project ID 20250578090 Q Statement of Non-Performance
CSLB# 922677 Awarding Body CITY OF LAKE ELSINORE
System Payroll# PRRUN3434141 U Final Payroll
eCPR Sequence# 2 Project Name Library Retaining Wall
Payroll Period 09/08/2025-09/14/2025 Project Address 124 W.SUMNER AVE.,
Contractor ENDRESEN LAKE ELSINORE,
DEVELOPMENT,INC CALIFORNIA,92530
Contract With CITY OF LAKE ELSINORE Project County RIVERSIDE
Employee: BAUTISTA BARRON,JOSE
Address SSN Check# 2867 Fringe Paid Directly to Worker
Hours Worked
Contributions
Craft/Classification/Level BRICKLAYER,BLOCKLAYER:OTHER(PLEASE SPECIFY)-Blocklayer- Vac/Holi H&W Pension Other Training Total Hourly Fringe
JOURNEYMAN 0.00 9.50 9.98 1.05 1.75 22.28
Type Sat Sun Mon Toe Wed Thu Fri Total Base Total
09/06 09/07 09/08 09/09 09/10 09/11 09/12 Hours Hourly Hourly Rate
S 0.00 0.00 8.00 8.00 8.00 8.00 8.00 40.00 52.58 74.86
Deductions(lump sum/non hourly rates) Payments Wages Summary
Fed Tax FICA State Tax SDI Fund/ Savings Dues Other Total Travel& Gross Wages Gross Wages Net Wages
(Soc Sec) Admin Deductions subsistence for all projects for this project Paid
511.87 185.65 222.29 35.93 0.00 0.00 0.00 43.42 999.16 0.00 2994.40 2994.40 1995.24
Employee Notes
$43.42 paid to Medical
Employee: GODINEZ,ALFONZO
Address SSN Check# null Fringe Paid Directly to Worker
Hours Worked
Contributions
Craft/Classification/Level BRICKLAYER,BLOCKLAYER:OTHER(PLEASE SPECIFY)-Blocklayer- Vac/Holi H&W Pension Other Training Total Hourly Fringe
JOURNEYMAN 0.00 9.50 9.98 1.05 1.75 22.28
Type Sat Sun Mon Tue Wed Thu Fri Total Base Total
09/06 09/07 09/08 09/09 09/10 09/11 09/12 Hours Hourly Hourly Rate
S 0.00 0.00 8.00 8.00 8.00 8.00 8.00 40.00 52.58 74.86
Deductions(lump sum/non hourly rates) Payments Wages Summary
Fed Tax FICA State Tax SDI Fund/ Savings Dues Other Total Travel& Gross Wages Gross Wages Net Wages
(Soc Sec) Admin Deductions subsistence for all projects for this project Paid
511.87 185.65 222.29 35.93 0.00 0.00 0.00 43.42 999.16 0.00 2994.40 2994.40 1995.24
Employee Notes
$43.42 paid to Medical
Certification under penalty of perjury:
"I,Josh Endresen,the undersigned,certify on 10/06/2025,that I have the authority to act for and on behalf of ENDRESEN DEVELOPMENT,
INC,certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the dates
09/08/2025 to 09/14/2025 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."
Public Works Certified Payroll Reporting Form 2026/01/15 Page-