HomeMy WebLinkAbout250729-25022-CPR-Lake Elsinore from 06.30.25-07.20.25 (weeks 4-6) 41 MR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of 6
NAME OF CONTRACTOR:Leonida Builders Inc CONTRACTOR'S LICENSE NO.:896772 ADDRESS:32023 Crown Valley Road,Acton,CA,
OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: 93510
PAYROLL NO. FOR WEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20250580287
1 4 7/6/2025 WORKERS'COMP:EAW0000186100 PROJECT AND LOCATION:City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S I S
NAME,ADDRESS �w � NET
AND SOCIAL
LL o o WORK Date TOTAL HOURL GROSS AMOUNT WAGES CHECK
o d ff a I CLASS- Y RATE DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 6/30 7/01 7/02 7/03 7/04 7/05 7/06 HOURS EARNED
OF PAY FOR
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 0.00 8.00 0.00 0.00 0.00 24.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALEGRIA ANAYA, /Cement
AURELIO Mason,Curb
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $15.36 $0.00 $0.00 $0.00 $0.00 $0.00 $607.21
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 5.00 6.00 0.00 0.00 0.00 19.00 $90.75 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ MARTIN,
RUBEN Operating $282.86 $197.86 $171.09 $31.04 $0.00 $71.63 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $20.90 $0.00 $0.00 $0.00 $0.00 $79.24 $762.09
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 8.00 0.00 0.00 0.00 32.00 $91.14 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ,MIGUEL
MARTIN Operating $306.47 $218.72 $135.30 $34.31 $0.00 $108.16 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $82.99 $777.79
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $92.70 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
CRUZ,JUAN
Fringes Sub Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $8.80 $0.00 $0.00 $0.00 $0.00 $0.00 $866.83
S=STRAIGHT TIME 'OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2 of 6
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 6/30 7/01 7/02 7/03 7/04 7/05 7/06 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 8.00 8.00 6.00 0.00 0.00 0.00 22.00 $94.41 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
CRUZ,JUAN
$2,077.02 $2,967.20 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Fs 24.20 $0.00 $0.00 $0.00 $0.00 $0.00 $866.83
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 2.00 0.00 0.00 0.00 2.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
Group 1 $148.58 $2,967.20 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $1.60 $0.00 $0.00 $0.00 $0.00 $0.00 $866.83
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $92.70 PROJECT PROJECTS Tax Medicarel Tax Holiday Welfare
FAVELA,VICTOR
Operating $242.14 $216.89 $129.71 $34.02 $0.00 $0.00 $0.00
I $741.60 $2,835.20 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $8.80 $0.00 $0.00 $0.00 $0.00 $0.00 $622.76
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 0.00 0.00 0.00 0.00 0.00 16.00 $94.41 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FAVELA,VICTOR
Operating $242.14 $216.89 $129.71 $34.02 $0.00 $0.00 $0.00
I $1,510.56 $2,835.20 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $622.76
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
FAVELA,VICTOR Mason,Curb
and Gutter $242.14 $216.89 $129.71 $34.02 $0.00 $0.00 $0.00
and Similar $583.04 $2,835.20 Training Fringes Dues Sub Savings Other Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $5.12 $0.00 $0.00 $0.00 $0.00 $0.00 $622.76
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of 6
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 6/30 7/01 7/02 7/03 7/04 7/05 7/06 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 4.00 0.00 8.00 0.00 0.00 0.00 20.00 $72.43 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ, /Cement
RAMON Mason,Curb
� and Gutter $169.42 $157.99 $117.77 $24.78 $0.00 $59.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 r$1
2.80 $0.00 $0.00 $0.00 $0.00 $287.49 $757.45
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 6.00 0.00 0.00 0.00 0.00 6.00 $72.86 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ,
I
RAMON Laborer and $169.42 $157.99 $117.77 $24.78 $0.00 $17.70 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $287.49 $757.45
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 8.00 0.00 0.00 0.00 32.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ, Laborer and
RAYMOND $335.84 $172.86 $143.97 $27.12 $0.00 $46.40 $0.00
Related
Group 1 $2,330.88 $2,330.88 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $25.60 $0.00 $0.00 $0.00 $0.00 $71.27 $751.06
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 0.00 8.00 0.00 0.00 0.00 24.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FRANCO /Cement
GARDUNO,RAUL Mason,Curb
and Gutter $227.54 $178.63 $151.68 $28.02 $0.00 $0.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.36 $0.00 $0.00 $0.00 $0.00 $0.00 $585.87
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 0.00 0.00 0.00 16.00 $71.10 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
HERNANDEZ, /Cement
RICARDO Mason,Curb
and Gutter
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $10.24 $0.00 $0.00 $0.00 $0.00 $91.94 $874.32
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of 6
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 6/30 7/01 7/02 7/03 7/04 7/05 7/06 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 6.00 6.00 8.00 0.00 0.00 0.00 28.00 $72.03 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
LOPEZ REYNOSO,
JOSE DEJESUS I Laborer and $159.79 $164.50 $129.64 $25.80 $0.00 $63.28 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $154.61 $634.34
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ORNTES, I Laborer and $264.65 $148.10 $110.86 $23.23 $0.00 $11.60 $0.00
Related
Group 1 $582.72 $1,964.16 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $6.40 $0.00 $0.00 $0.00 $0.00 $28.15 $574.99
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 0.00 0.00 0.00 16.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
PADILLA,HECTOR Mason,Curb
and Similar $1,166.08 $2,334.98 Training Fringes Dues Sub Savings Other Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $10.24 $0.00 $0.00 $0.00 $0.00 $0.00 $458.63
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 0.00 0.00 0.00 16.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
RAMIREZARANDA, /Cement
ROBERTO Mason,Curb
and Gutter $110.72 $175.74 $85.33 $27.57 $0.00 $0.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $10.24 $0.00 $0.00 $0.00 $0.00 $105.36 $504.72
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $71.43 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
RAMIREZ,JUAN Mason,Curb
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $5.12 $0.00 $0.00 $0.00 $0.00 $156.45 $820.80
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 5 of 6
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 6/30 7/01 7/02 7/03 7/04 7/05 7/06 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
RAMIREZ,JUAN Laborer and
Group 1 $582.72 $2,299.86 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $6.40 $0.00 $0.00 $0.00 $0.00 $156.45 $820.80
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 4.00 0.00 0.00 0.00 0.00 0.00 4.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ROMO,ARMANDO
I
CARDONA Laborer and $208.14 $182.67 $93.31 $28.65 $0.00 $0.00 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $3.20 $0.00 $0.00 $0.00 $0.00 $0.00 $512.77
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
SALAZAR, Mason,Curb
MODESTO and Gutter $270.11 $179.59 $89.77 $28.17 $0.00 $0.00 $0.00
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $5.12 $0.00 $0.00 $0.00 $0.00 $18.36 $586.00
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
SALAZA , I Laborer and $270.11 $179.59 $89.77 $28.17 $0.00 $0.00 $0.00
MODESRelated
Group 1 $1,782.96 $2,366.00 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $19.20 $0.00 $0.00 $0.00 $0.00 $18.36 $586.00
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 0.00 0.00 0.00 16.00 $69.11 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
VEGA,RUTILIO Mason,Curb
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $10.24 $0.00 $0.00 $0.00 $0.00 $177.15 $808.68
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CANOR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 6 of 6
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
CONTRACTOR/SUBCONTRACTOR CONTRACT NUMBER
Leonida Builders Inc 20250580287
FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD
6/30/2025 7/6/2025
1 do hereby certify under penalty of perjury:
(1) That I pay or supervise payment to employees of the above—referenced contractor on the above—referenced contract.All persons employed on said project for the above—referenced time period have been
paid their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and that no
deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions.
(2) That this employer has complied with the requirements of the California Labor Code Sections. 1771, 1811,and 1815 for all performed on this public works project,and that the classifications set forth therein
for each trade rate conform with the work performed.
(3) That any payrolls otherwise under this control required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the
applicable wages rates:
(a) 0 Specified in the applicable wage determination incorporated into the contract;
(b) FX Determined by the Director of Industrial Relations for the county or counties in which the work is performed;that the classification set forth therein for each laborer or mechanic conform
with the work he or she performed.
(4) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(5) That fringes benefits as listed in the contract:
(a) 0 Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed employee(s),except as noted below.
(b) FX Have been paid directly to the listed employee(s),except as noted below.
(c) 0 See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
Training. Training paid to California Apprenticeship Council.
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
NAME(PLEASE PRINT.) TITLE
Panagiotis Leonida PRESIDENT
SIGNATURE: Pan lbk Le&Lt�L,a a DATE
w 7/29/2025
F
federally—funded projects, permissible deductions are defined in title 29,Code of Federal Regulations, part 3,issued by the Secretary of Labor under the Copeland Act,(40 U.S.C.276c).Also,the willful
ification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution(See section 1001 of title 18 and section 3729 of title 31 of the United States Code).
ADA Notice For individuals with sensory disabilities,this document is available in alternate formats. For information call(916)654-6410 or TDD(916)654-3880 or write Records and Forms CEM 2503
Management, 1120 N Street, MS-89,Sacramento,CA 95814.
41 MR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of 7
NAME OF CONTRACTOR:Leonida Builders Inc CONTRACTOR'S LICENSE NO.:896772 ADDRESS:32023 Crown Valley Road,Acton,CA,
OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: 93510
PAYROLL NO. FOR WEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20250580287
1 5 7/13/2025 WORKERS'COMP:EAW0000186100 PROJECT AND LOCATION:City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S I S
NAME,ADDRESS �w � NET
AND SOCIAL
LL o o WORK Date TOTAL HOURL GROSS AMOUNT WAGES CHECK
o d ff a I CLASS- Y RATE DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS EARNED
OF PAY FOR
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 8.00 0.00 0.00 24.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALEGRIA ANAYA, /Cement
AURELIO Mason,Curb
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $15.36 $0.00 $0.00 $0.00 $0.00 $0.00 $845.55
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $88.93 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ MARTIN,
RUBEN Operating $284.94 $198.58 $172.06 $31.15 $0.00 $7.54 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $2.20 $0.00 $0.00 $0.00 $0.00 $79.24 $765.97
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 8.00 6.00 0.00 0.00 0.00 0.00 14.00 $90.75 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ MARTIN,
RUBEN Operating $284.94 $198.58 $172.06 $31.15 $0.00 $52.78 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.40 $0.00 $0.00 $0.00 $0.00 $79.24 $765.97
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 1.00 0.00 0.00 0.00 1.00 $91.03 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ,MIGUEL
MARTIN Operating $465.25 $273.93 $209.14 $42.97 $0.00 $3.38 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $1.10 $0.00 $0.00 $0.00 $0.00 $82.99 $1,074.2
8
S=STRAIGHT TIME 'OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2 of 7
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 3.00 8.00 0.00 0.00 35.00 $91.14 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ALVAREZ,MIGUEL
MARTIN Operating $465.25 $273.93 $209.14 $42.97 $0.00 $118.30 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Fs $1,074.
38.50 $0.00 $0.00 $0.00 $0.00 $82.99 8
8
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $94.41 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
CRUZ,JUAN
$2,265.84 $3,395.44 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $26.40 $0.00 $0.00 $0.00 $0.00 $0.00 $1,051.3
2
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 2.00 0.00 0.00 0.00 0.00 18.00 $92.70 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FAVELA,VICTOR
Operating $349.90 $251.24 $175.64 $39.41 $0.00 $0.00 $0.00
I $1,668.60 $3,284.18 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $19.80 $0.00 $0.00 $0.00 $0.00 $0.00 $816.19
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $94.41 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FAVELA,VICTOR
Operating $349.90 $251.24 $175.64 $39.41 $0.00 $0.00 $0.00
I $188.82 $3,284.18 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $816.19
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 4.00 0.00 0.00 0.00 0.00 4.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FAVELA,VICTOR I Laborer and $349.90 $251.24 $175.64 $39.41 $0.00 $0.00 $0.00
I Group 1 $297.16 $3,284.18 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $3.20 $0.00 $0.00 $0.00 $0.00 $0.00 $816.19
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of 7
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 8.00 0.00 0.00 24.00 $72.43 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ, /Cement
RAMON Mason,Curb
� and Gutter $260.04 $202.58 $177.40 $31.78 $0.00 $70.80 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 r$1
5.36 $0.00 $0.00 $0.00 $0.00 $287.49 $959.29
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $72.86 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ,
I
RAMON Laborer and $260.04 $202.58 $177.40 $31.78 $0.00 $47.20 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $287.49 $959.29
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $71.43 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
FERNANDEZ, Mason,Curb
RAYMOND and Gutter $472.66 $216.58 $202.42 $33.97 $0.00 $11.60 $0.00
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $5.12 $0.00 $0.00 $0.00 $0.00 $71.27 $996.90
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 8.00 0.00 0.00 0.00 32.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FERNANDEZ, Laborer and
RAYMOND $472.66 $216.58 $202.42 $33.97 $0.00 $46.40 $0.00
Related
Group 1 $2,330.88 $2,902.32 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $25.60 $0.00 $0.00 $0.00 $0.00 $71.27 $996.90
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 8.00 0.00 0.00 16.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
FRANCO /Cement
GARDUNO,RAUL Mason,Curb
and Gutter $355.19 $223.01 $211.03 $34.98 $0.00 $0.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $10.24 $0.00 $0.00 $0.00 $0.00 $0.00 $824.21
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of 7
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
GOMEZ VALDIVIA, /Cement
M Curb
JOEL ason, ur
� and Gutter $344.25 $212.88 $200.64 $33.39 $0.00 $0.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $5.12 $0.00 $0.00 $0.00 $0.00 $200.00 $991.16
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $71.10 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
HERNANDEZ, /Cement
RICARDO Mason,Curb
and Gutter $500.34 $203.08 $181.23 $31.86 $0.00 $14.24 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $5.12 $0.00 $0.00 $0.00 $0.00 $91.94 $1,008.4
5
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 6.50 8.00 4.00 8.00 0.00 0.00 34.50 $72.03 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
LOPEZ REYNOSO,
JOSE DEJESUS I Laborer and $217.16 $200.32 $177.53 $31.42 $0.00 $77.97 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $27.60 $0.00 $0.00 $0.00 $0.00 $154.61 $781.04
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 8.00 8.00 0.00 0.00 40.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ORNTES, I Laborer and $485.72 $220.74 $207.99 $34.63 $0.00 $58.00 $0.00
Related
Group 1 $2,913.60 $2,913.60 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $28.15 $977.23
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
PADILLA,HECTOR Mason,Curb
and Similar $583.04 $2,332.16 Training Fringes Dues Sub Savings Other Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator $5.12 $0.00 $0.00 $0.00 $0.00 $0.00 $457.79
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 5 of 7
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 8.00 0.00 0.00 16.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
RAMIREZARANDA, /Cement
ROBERTO Mason,Curb
� and Gutter $223.96 $220.12 $137.18 $34.53 $0.00 $0.00 $0.00
type of screed
Operator D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 r$1
0.24 $0.00 $0.00 $0.00 $0.00 $105.36 $721.15
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 8.00 8.00 0.00 0.00 16.00 $71.43 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
RAMIREZ,JUAN Mason,Curb
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $1,059.6
Operator $10.24 $0.00 $0.00 $0.00 $0.00 $156.45 5
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 2.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 $94.41 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ROMO,ARMANDO
CARDONA Operating $147.66 $144.12 $57.13 $22.61 $0.00 $0.00 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $371.52
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 3.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 $94.52 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ROMO,ARMANDO
CARDONA Operating $147.66 $144.12 $57.13 $22.61 $0.00 $0.00 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $3.30 $0.00 $0.00 $0.00 $0.00 $0.00 $371.52
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 3.00 0.00 0.00 5.00 8.00 0.00 0.00 16.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
ROMO,ARMANDO
CARDONA I Laborer and $147.66 $144.12 $57.13 $22.61 $0.00 $0.00 $0.00
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $371.52
S=STRAIGHT TIME *OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CAICalifornia Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 6 of 7
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S S
NAME,ADDRESS 0`� � NET
LL o o WORK Date HOURL WAGES
AND SOCIAL o E 0 TOTAL GROSS AMOUNT CHECK
o a CLASS- Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/07 7/08 7/09 7/10 7/11 7/12 7/13 HOURS OF PAY
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.88 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
SALAZAR, Mason,Curb
MODESTO and Gutter $412.74 $225.06 $143.78 $35.30 $0.00 $0.00 $0.00
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
Operator r$5.12 $0.00 $0.00 $0.00 $0.00 $18.36 $835.24
THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
SALAZA , I Laborer and $412.74 $225.06 $143.78 $35.30 $0.00 $0.00 $0.00
MODESRelated
Group 1 $1,782.96 $2,960.32 Training Fringes Dues Sub Savings Other Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $19.20 $0.00 $0.00 $0.00 $0.00 $18.36 $835.24
Cement Mason THIS ALL Federal FICA& State SDI Vacation Health& Pension
S 8.00 0.00 0.00 8.00 8.00 0.00 0.00 24.00 $69.11 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
/Cement
VEGA,RUTILIO Mason,Curb
and Similar Fringes Sub Deduct.
type of screed D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $1,063.6
Operator $15.36 $0.00 $0.00 $0.00 $0.00 $177.15 2
S=STRAIGHT TIME 'OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CANOR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 7 of 7
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
CONTRACTOR/SUBCONTRACTOR CONTRACT NUMBER
Leonida Builders Inc 20250580287
FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD
7/7/2025 7/13/2025
1 do hereby certify under penalty of perjury:
(1) That I pay or supervise payment to employees of the above—referenced contractor on the above—referenced contract.All persons employed on said project for the above—referenced time period have been
paid their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and that no
deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions.
(2) That this employer has complied with the requirements of the California Labor Code Sections. 1771, 1811,and 1815 for all performed on this public works project,and that the classifications set forth therein
for each trade rate conform with the work performed.
(3) That any payrolls otherwise under this control required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the
applicable wages rates:
(a) 0 Specified in the applicable wage determination incorporated into the contract;
(b) FX Determined by the Director of Industrial Relations for the county or counties in which the work is performed;that the classification set forth therein for each laborer or mechanic conform
with the work he or she performed.
(4) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(5) That fringes benefits as listed in the contract:
(a) 0 Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed employee(s),except as noted below.
(b) FX Have been paid directly to the listed employee(s),except as noted below.
(c) 0 See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
Training. Training paid to California Apprenticeship Council.
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
NAME(PLEASE PRINT.) TITLE
Panagiotis Leonida PRESIDENT
SIGNATURE: Pan lbk Le&Lt�L,a a DATE
w 7/29/2025
F
federally—funded projects, permissible deductions are defined in title 29,Code of Federal Regulations, part 3,issued by the Secretary of Labor under the Copeland Act,(40 U.S.C.276c).Also,the willful
ification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution(See section 1001 of title 18 and section 3729 of title 31 of the United States Code).
ADA Notice For individuals with sensory disabilities,this document is available in alternate formats. For information call(916)654-6410 or TDD(916)654-3880 or write Records and Forms CEM 2503
Management, 1120 N Street, MS-89,Sacramento,CA 95814.
41 MR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of 2
NAME OF CONTRACTOR:Leonida Builders Inc CONTRACTOR'S LICENSE NO.:896772 ADDRESS:32023 Crown Valley Road,Acton,CA,
OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: 93510
PAYROLL NO. FOR WEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20250580287
1 6 7/20/2025 WORKERS'COMP:EAW0000186100 PROJECT AND LOCATION:City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk
(1) (2) (3) (4)DAY (5) (6) (7) (8) (9)
M I T I W I T I F I S I S
NAME,ADDRESS �w � NET
AND SOCIAL
LL o o WORK Date TOTAL HOURL GROSS AMOUNT WAGES CHECK
o d ff a I CLASS- Y RATE DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °z=w IFICATION 7/14 7/15 7/16 7/17 7/18 7/19 7/20 HOURS EARNED
OF PAY FOR
OF EMPLOYEE 3 w I WEEK
Hours Worked Each Day
THIS ALL Federal FICA& State SDI VacationM
on
S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $72.84 PROJECT PROJECTS Tax Medicare Tax Holiday
ORNTES, I Laborer and $306.23 $162.56 $130.20 $25.50 $0.0000
Related
Group 1 $582.72 $2,153.16 Training Fringes Dues Sub Savingst.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00I I $6.40 $0.00 $0.00 $0.00 $0.0064
S=STRAIGHT TIME 'OTHER-Any other deductions,contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O=OVERTIME Use extra sheet(s)if necessary. (See reverse side)
Form A-1-131(New 2-80) D=DOUBLETIME
SDI=STATE DISABILITY INSURANCE
CANOR California Department of City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2 of 2
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
CONTRACTOR/SUBCONTRACTOR CONTRACT NUMBER
Leonida Builders Inc 20250580287
FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD
7/14/2025 7/20/2025
1 do hereby certify under penalty of perjury:
(1) That I pay or supervise payment to employees of the above—referenced contractor on the above—referenced contract.All persons employed on said project for the above—referenced time period have been
paid their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and that no
deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions.
(2) That this employer has complied with the requirements of the California Labor Code Sections. 1771, 1811,and 1815 for all performed on this public works project,and that the classifications set forth therein
for each trade rate conform with the work performed.
(3) That any payrolls otherwise under this control required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the
applicable wages rates:
(a) 0 Specified in the applicable wage determination incorporated into the contract;
(b) FX Determined by the Director of Industrial Relations for the county or counties in which the work is performed;that the classification set forth therein for each laborer or mechanic conform
with the work he or she performed.
(4) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(5) That fringes benefits as listed in the contract:
(a) 0 Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed employee(s),except as noted below.
(b) FX Have been paid directly to the listed employee(s),except as noted below.
(c) 0 See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
Training. Training paid to California Apprenticeship Council.
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
NAME(PLEASE PRINT.) TITLE
Panagiotis Leonida PRESIDENT
SIGNATURE: Pan lbk Le&Lt�L,a a DATE
w 7/29/2025
F
federally—funded projects, permissible deductions are defined in title 29,Code of Federal Regulations, part 3,issued by the Secretary of Labor under the Copeland Act,(40 U.S.C.276c).Also,the willful
ification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution(See section 1001 of title 18 and section 3729 of title 31 of the United States Code).
ADA Notice For individuals with sensory disabilities,this document is available in alternate formats. For information call(916)654-6410 or TDD(916)654-3880 or write Records and Forms CEM 2503
Management, 1120 N Street, MS-89,Sacramento,CA 95814.