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Home My WebLink About250917-25022-CPR-Lake Elsinore from 09.01.25-09.07.25 (week 13) 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 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 13 9/7/2025 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 9/01 9/02 9/03 9/04 9/05 9/06 9/07 HOURS EARNED OF PAY FOR OF EMPLOYEE 3 w I WEEK Hours Worked Each Day THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Group 1 $1,188.64 $1,748.64 Training Fringes Dues Sub Savings Other M 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 $0.00THIS ALL Federal FICA& State SDI Vacation Health& S 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 $92.70 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare FAVELA,VICTOR � Operating $59.60 $156.31 $64.49 $24.52 $0.00 $0.00 $0.00 I $1,483.20 $2,043.20 Training Fringes Dues Si Other Sub Savings er 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 $304.92 THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 3.00 0.00 0.00 0.00 0.00 0.00 3.00 $89.75 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare FERNANDEZ, RAMON Operating $316.77 $222.31 $203.78 $34.87 $0.00 $8.85 $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 $287.49 $1,065.2 2 THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $91.46 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare FERNANDEZ, 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 $287.49 $1,065.2 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 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 4 (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 9/01 9/02 9/03 9/04 9/05 9/06 9/07 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 4.00 4.00 0.00 0.00 0.00 0.00 8.00 $72.86 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare FERNANDEZ, RAMON I Laborer and $316.77 $222.31 $203.78 $34.87 $0.00 $23.60 $0.00 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 $287.49 $1,065.2 � 2 THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $74.29 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare LOERA,ESTEBAN 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 $0.00 $483.42 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 $83.38 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare LOPEZ REYNOSO, Iron Worker/ JOSE DEJESUS Iron Worker $288.76 $225.22 $210.83 $35.33 $0.00 $4.52 $0.00 (Area 4) D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $1.44 $0.00 $0.00 $0.00 $0.00 $154.61 $914.75 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 $72.03 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare LOPEZ REYNOSO, JOSE DEJESUS I Laborer and $288.76 $225.22 $210.83 $35.33 $0.00 $31.64 $0.00 D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $154.61 $914.75 THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $75.39 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare RAM I REZ ARAN DA, ROBERTO I Laborer and $86.03 $160.00 $70.82 $25.10 $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 $6.40 $0.00 $0.00 $0.00 $0.00 $105.36 $447.31 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 4 (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 9/01 9/02 9/03 9/04 9/05 9/06 9/07 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 $1,714.16 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 $156.45 $580.19 THIS ALL Federal FICA& State SDI Vacation Health& Pension S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $71.62 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare VEGA,RUTILIO Laborer and Group 3 $572.96 $2,014.88 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 $6.40 $0.00 $0.00 $0.00 $0.00 $177.15 $745.71 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 4 of 4 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 9/1/2025 9/7/2025 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 9/17/2025 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.