2016-08 Urban Habitat WE 2019-12-28PAYROLL
(For Contractor's Optional Use; See instructions, Form WH-347 Inst.)
NAME OF CONTRACTOR OR SUBCONTRACTOR ❑ Wage CA-SC-UH
ADDRESS PO Box 1177
Urban Habitat Det:
Le Quinta, CA 92247
PAYROLL NO.
FOR WEEK END[NG
PROJECT AND LOCATION
PROJECT OR CONTRACT NO
11.0
12/2812019
La Quinta SilverRock Park Venue
2016-0812016-08
La Quinta SilverRock Resort
(1)
(2)
(3)
F (4) DAY AND DATE
(5)
(6)
(7)
(a) • Other Deductions - 1) Local Tax 1
(9)
z z
DEDUCTIONS 2) Local Tax 2
NET
o SUN
MDN
TUE
weD
THU FRI
SAT
D
~
3) other Deductions
O 22
23
24
25
28 27
28
NAME, ADDRESS, AND
a o ii
WORK
WAGES
PAID
ITN-
HOLDING
TOTAL
Idenlifi Number
z
° F
CLASSIFICATION
W
TOTAL
RATE
GROS5
AMOUNT
FOR WEEK!
HOURS WORKED EACH DAY
EMPLOYEE
OF EMPLOYEi=
z 3
HOURS
OF PAY
EARNED
FICA
TA)(
SvVH
Medicare
OTHER'
DEDUCTIONS
Check No.
Sex Race
Alejandro Aguayo
Landscape Irr. Tender
D 0
c
o-
a
o
o-
0
0.00
0.00 c.00
122.40
1) 0.00
84711 Ave 51
2) 0.00
O 0
0
0
0
0
0
a
0.00
❑,00 aco
Coachella, CA 92238
3
7.59
0.00
0.00
1.77
3) 1.22
10.58
111.82
5 a
0
0
0
0
s.00
a
8.00
+5.3a o_00
61692691g
122.40
61817
Male Hispanic American
Fringe ueta0: Hearin & vvenare: $1V, W1$2.45, Pension: $8.001$1.00, Annuity: $2.00I$0.25, Vacation: $8.241$1.03
Other Deducilon Detail: SDI: 1.22
Josue Arce
4046 Dwight Ave.
Riverside, CA 92507
3
Cement Mason
D 0
0
0
0
0
0
❑
0,00
1 .00 o.oa
74,00
4.59
0.00
0.00
1 07
1) 0.00
2) 0,00
3) 0.74
6 40
67 60
0 0
a
o
0
0
❑
❑
0.00
0,c❑ 0.co
S o
00
o
a
o
a
0
4,00
0.00
611506098
Apprentice Level 1
74,00
61844
Male Hispanic American
lieso
Fringe ueiaa: Annuty: $2.UU1$U.7U, training Tuna: $C.rtusu,[ty, Pension: $16.4Ur$4.10, Contract Compliance: $1.201$0.30, Indust. Stab.Fund: $0.321$0.08. Administrative Fund: $0.241$0.06, Health & Welfare: $17,6044.40,
Vacation: $4.%W.24
Other Deduction Detail: SDI: 0,74
Clanlel J- CBIV@r
Stoddard Wells Rd.
Apple Valley, CA 92307
4
dscape irrigation
abor
p a
o
0
0
0
0
o
O.IH)
0.00 0.00;106/-20
1279
0.00
0.00
2 99
1) O.11020715
2) 0.00
S) 2.06270717343
17 84
188.45
0 0
000
00
0
0.00
0.00 n_00
5 0
0
0
0
o
a0o
a
300
as es o.a❑06,29
61822
Male Caucasian
Fringe Detail: Health & Welfare: $22.411$7.47, Pension: $25.201$8.40, Annuity: $1.501$0.50. Vacation: $14.61/$4.87, Training Fund: $2271$0.69, Contract Compliance: $0.9WS0.30, Administrative Fund: $0.18f$0.06, Indust.
Stab.Fund:$0.36/$0.12
Other Deduction Detail: SDI: 2.06
Luis M. Castaneda
5 Running H
Palm Desert, CA 92260
2
Cement Mason
D 0
0
o
o
a
o
0
0.00
om o.w
148.00
9.18
0.00
0.0U
2.15
+) 0.00
2) 0,00
3) 126.05
137.38
10,62
0 0
0
0
0
a
o
a
0,00
Do Do
S 0
a.00
0
0
0
0
❑
4,00
sz0c c.0o
547439373
148,00
61847
Male
Fringe uerau: vacadon: $sc.ausn.[s, Heann & Welfare; TZW361$7-41, Pension: $33.601$6.40, Annuity: $2.001$0.50, Training Fund: $2 7W$0.69, Contract Compliance: $1.201$0.30, Indust. Stab.Fund: $0.321$0.08, Other.
$0.28/$0.07, Administrative Fund: $0.241$D.06
Other Deduction Detail: SDI; 14.80, Child Support Fee: 1.50, Child Support: 23,07, State Tax Lien, 86.68
While oompletion of Form WH 347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.50). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C_F.R § 5.5{a)(3){ii) require contractors to submit weekly a copy of ail payroll$ to the Federal agency contracting far orfinancing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been pad not less than the proper Devis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
NAME OF CONTRACTOR OR SUBCONTRACTOR Wage CA-SC-UH
ADDRESS PO Box 1177
Urban Habitat DeC
La Quinta, CA 92247
PAYROLL NO. FOR WEEK ENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
14-0 12/26/2019
La Quinta SilverRock Park Venue
2016-0812016-09
Le Quinta SilverRock Resort
(t)
(2)
(3)
(4) DAY AND DATE
°
(5)
(6)
(7)
(5) ' Other Deductions - 1) Local Tax 1
(9)
O
DEDUCTIONS 2) Local Tax 2
is SUN
MU TUE
WLO
THU
FRI SAT
Zz
3) Other Deductions
NET
DO
w s
NAME. ADDRESS, AND
LL
WORK
GROSS
PAID
22
23 24
25
26
27 28
IdentMoation Number
o C
CLASSIFICATION
m
TOTAL
RATE
AMOUNT
W ITH-
HOLDING
TOTAL
FOR MEW
HOURS WORKED EACH DAY
OF EMPLOYEE
y
HOURS
OF PAY
EARNED
FICA
TAX
SWH
Medicare
OTHER'
DEDUCTIONS
Check No.
Sex Race
Cameron D. Cleland
andscape Oper. Eng
D o
a
0
0
0
0
0
0.00
mo om;4171.05
1) 0,00
20250 Itasca Rd.
2
2} 0.0048.75
Apple Valley, CA 92308
0±�o±110±OD
0
0.00
0.00 0.00
29.21
8.00
0.00
6,83
3) 4.71
422.30
S
o
..00
3a.45 0.00
565931366
61B19
Male Caucasian
Fringe Detail: Health & Welfare: $88.8&$9.87, Pension: $88.831$9.87, Vacation: $43.561$4.84, Training Fund: $13.501$1.50, Annuity: $2,251$0.25, Contract Compliance: $2.70/$0.30, Administrative Fund: $0.541$0.06, Indust.
Stab.Fund: $1.081$0.12
Other Deduction Detail: SDI: 4.71
Pedro J. Clemente
68990 Harrison St Space #101
Thermal, CA 92274
5
Landscape Irrigation
abor
p 0
0
c
o
0
a
o
0.00
o.0a 0 00
170.06
27.13
DAO
0.00
6.34
1) 0,00
2) 4.38
3) 4.38
37.85
399,65
o
0
0
o
a
6
9
0.00
c.oD 0 00
S 0
4.80
0
0
0
0
0
4.60
3543 000
657090571
437.50
61857
Male
Fringe Detail: Annuity: $2.40t$0.50, Training Fund: $3.3121$0.69, Pension: $40.321$8.40, Health & Welfare: $35.8561$7.47, Vacation: $23.3761$4.87, Contract Compliance: $1,441$1 Administrative fund: $0.288f$0.06,
Indust. Stab.Fund: $0.5761
Other Deduction Detail: SDI: 4.38
PedroJ.Ciemente
68990 Harrison St. Space #101
Thermal, CA 92274
5
andscape Irrigation
abor
D o
o
0
0
0
0
0
v.00
von om
207,44
27.13
0.00
0.00
6.34
1) 000
2) 0.00
3) 4.38
37.85
399.65
p o
0
o
o
0
0
0
0.00
o.0c 000
S 0
0
0
0
0
500
0
8,00
33.43 O,CD
657090571
437.50
61857
Male
1
Fringe Detail: Annuity: $4.001$0.50, Training Fund: $5.521$0.89, Pension: $67.201$8A0, Health & Welfare: $59.76/$7.47, Vacation: $38,961$4.87, Contract Compliance: $2.401$0.30, Administrative Fund: $0.4B1$C.06, Indust.
Stab.Fund:$0.961$0,12
Oaten Deduction Detail: SDI: 4.38
Maurillo P. Cortez
55550 Tyler St,
Thermal, CA 92274
5
Landscape Irrigation
Labor
D 0
0
0
0
0
0
0
0.00
0.00 oa07251-10
0.00
0.00
3.71
1) 0.00
2) D.Do
3i 2.56
22 14
233 86
0 o
a
o
0
a
o
0
0.00
o oo "'115.87
S o
4,e0
0
0
o
8.00
0
12,80
z000 n.0a
60452i749
Apprentice
6185D
Maio Hisuanic American
Fringe Detail: Training Fund: $8.8321$0.69, Annuity: $6.401$0.50, Pension, $52.481$4.10, Contract Compliance: $3.841$0.30, Indust. Stab.Fund: $1.02440.08, Administrative Fund: $0.76W$0.06, Hea11h & Welfare: $56.
32r$4.40, Vacation: $15.872/$1.24
Other Deduction Detail: SDI: 2,56
White completion of Form VVH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 33, 5.5{a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "Furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F,R. § 5.5{a){3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for oriinandng the construction project,
aocompartied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and [hat each laborer or mechanic has been paid not less than the proper Davis -Bacon prevailing wage rate for the work performed,
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
NAME OF CONTRACTOR n OR SUBCONTRACTOR Wage CA-SC-UH
ADDRESS PO Box 1177
Urban Habitat Det:
La Quinta, CA 92247
PAYROLL NO
FOR WEEK ENDING
PROJECT AND LOCATION PROJECT OR CONTRACT No
11.D
1212812019
La Quinta SilverRock Park Venue 2016-0812016-08
La Quinta SilverRock Resort
(4) DAY AND DATE
o
(5)
(6)
(7)
(8) Other Deductions- 1) Local Tax 1
(8)
O �,
DEDUCTIONS 2) Loral Tax 2
`a SUN
MON
THE WED
THU
FRI
SAT
Z Z
�4
3} Other Deductions
NET
NAME, ADDRESS. AND
WORK
WAGES
PAID
m 22
23
24 25
26
27
2$
W17H-
HOLDING
TOTAL
Identification Number
o=�
w
CLASSIF[CATION
TOTAL
RATE
GROSS
AMOUNT
FOR WEEIQ
HOURS WORKED EACH DAY
OF EMPLOYEE
z 3 w
}TOURS
OF PAY
EARNED
FICA
TAX
SvVH
Medicare
OTHER'
DEDUCT40NS
Check No.
Sex Race
Ernesto Gonzalez Torres
Landscape irrigation
D 0
o
o
o
a
a
o
0.00
QOn Due
138.96
1) 0.00
61101 Grapefruit Blvd. #6
abor
2) 0.00
O o
n
o
0
0
0
o
I).00
0.00 0 0a
Thermal, CA 92274
2
17.23
4.0o
O.Oo
a_o3
3y 2 78
28.04
249.88
S o
4.co
0
0
u
400
0
8.00
ao
617157389
prenticeLevel I
277.92
61827
Male
�,i?37
Fnnge Detail: Health & Welfare: $35.201$4.40, Cooperation Comm.: $2.401$0.30, Training Fund: $10.721$1.34, Indust. Stab Fund: $0 64f$0.08, Vacation: $10.081$1.26, Penslow $34.08/$4.26, Annuity: $2.001$0.25,
Administrative Fund: $0.481$0.06
Other Deduction Detail: SDI: 2,78
Luis F. Lopez Quintero
66886 Camino Idilio
Desert Hot Springs, CA 92240
4
Landscape Irrigation
Labor
D o
o44-
a
0.00
o.ou ono
222.33
13.79
0.00
0.00
3.22
1) 0.00
2) O.00
3) 2 22
19.23
203.11
O a
0
0
0.00
c.aa oa0
S 0
4,80
n
12.8p
17.37 000
164777350
Apprentice Level 1
222,34
01846
Male
Frnge Detail: Health & Welfare: $95.6161$7.47, Pension: $120.321$9.40, Training Fund: $a.B321S0.139, Annuity: $6.401$0.50, Vacation: $62.3361$4.87, Contract Compllance: $3.841$0.30, Administrative Fund: $0.7581$0.06,
Indust. Stab.Furd: $1.5361$0.12
Other Deduction Detail: SDI: 2.22
Juan LopezMendez
Tyler St. Space #3
Thermal, CA 92274
Landscape irrigation
Labor
D o
0
0
0
0
0
0
000
000 0.00
;160.46
9.94
0.00
0.00
2.33
1) 0.055550
2) 0.00
3) 1.61
1386
146.58
4 0
0
0
o
o
o
0
0,00
a.0n 0.00
S 6
4.80
0
0
0
0
4afl
3343 0.0060.46
620099088
61844
Male
Fringe Detail, Annuity: $2.401$0.50, Pension, $40.321$8.40, Training Fund: $3.3121$0.69, Vacation: $23.3761$4.87, Health & Welfare: $35.856/$7.47, Contract Compliance: $3.3121$0.69, Administrative Fund: $0.2881$0.06,
Indust. Stab.Fund: $0.5761$0.12
Other Deduction Detail: SDI: 1.61
Felipe Lopez
66886 Camino Idilio
Desert Hot Springs, CA 92240
5
Landscape Oper. Eng
D 0
0
0
0
0
o
o
0.00
ooa coo;491
.16
30.51
0,00
D.00
7.14
11 0.00
2) 0.00
3) 4.92
42.57
449.59
0 c
u
0
0
0
0
o
0A0
o,0a 0.00
S o
400
0
0
o
a 00
0
12.80
3s,4s a o0
604137146
61828
Male
Fringe Detail: Health & Welfare: $126.3361$9.87, Pension: $126.3361$9.87, Vacation: $61.952/$4.84, Annuity: $3.201$0.25, Training Fund: $19201$1.50, Contract Compliance: $3.8W$0.30, Administrative Fund. $0.7681$0.D6,
Indust, Stab Fund, $153.601$12.00
Other Deduction Detai€: SDI: 4.92
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained In 29 C.F.R.
§§ 3.3, 5 5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work an Federally financed or assisted construction contracts to "furnish weekly a statement With respect to the wages paid each emptoyee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of ail payrolls to the Federal agency contracting for or flnaneang the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrotts are correct and complete and that each laborer or rnedfanic has been paid not less than the proper t3avis Bacon prevailing wage rate for the work performed.
DOL and tederal contracting agencies receiving this information review the information to determine that employees have received legalty required wages and frtnge benefits.
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
NAME OF CONTRACTOR Q OR SUBCONTRACTOR Wage CA-SC-UH
ADDRESS PO Box 1177
Urban Habitat Det:
La Quinta, CA 92247
PAYROLL NO.
FOR WEEK ENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
11.0
12/2812019
La Quints SilverRock Park Venue
2016-0012016-08
La Quints SilverRock Resort
(1)
(2)
(3)
(4) DAY AND DATE
(5)
(6)
(7)
(8) ' Other Deductions - 1) Look Tax 1
(9)
0 m
DEDUCTIONS 2) Local Tax 2
a SUN
S
MON
TUE
WED
THU
FRI
3AT
z 2
o
3} Other Deductions
NET
NAME, ADDRESS. AND
O
LL =d
WORK
WAGES
- 22
`w
23
24
25
26
27
2$
HOL�IN6
T07AL
ldentificaf%on Number
o
CLASSIFICATION
TOTAL
RATE
AMOUNT
FORAID VVEEK/
HOURS WORKED EACH DAY
OF EMPLOYEE
z 3
HOURS
OF PAY
EARNED
FICA
TAX
SWH
Medicare
OTHER"
DEOUCTOW
Check No,
Sex Race
Jose A. 1Vteza Vera
andscape lrr. Tender
p o
o
a
o
0
a
o
0.00
0.00 0.00
122.4R
1) 0.00
82292 Lemongrove
0 0
o
a
o
a
o
0
0.00
0,00 am
India, CA 92201
2
7.59
0-00
0.00
1.77
3f 1022
10.58
111.82
S 0
0
0
0
0
8.00
o
8,00
15.3o 0.00
622188359
122.40
61838
Male Hispanic American
Fringe Detail: Annuity: 52.00f$0.25, Health & Welfare; $19.60/$2.45, Vacation: $8.241$1.03, Pension: $8.001$1.OD
Other Deduction Detail: SDI: 1.22
Kenneth P. Ocean
15214 Mission St.
Hesperia, CA 92345
0
andscape Irrigation
Labor
D o
0
0
0
0
a
0.00
0.00 oon;2/5715
3.73
4.00
15.84
3.00
1) 0.00
2) 0.00
3) 2 57
25.24
231,91
D o
o
❑
❑
o
0
0
0.00
aoo o00
S q
o
0
0
0
3.00
0
3.00
33 43 a ao.
559657836
61845
Male
Fringe Detau: Hearin a vvenare: $zz.41r$1,41, Pension: $29.2fJ1$8.40, Annuity: $1.501$0.50, Vacation; $14.611$4.87, Training Fund: $2.071$0.69, Contract Compliance: $0.901$0.30, Administrative Fund: So 181$0.06, Indust.
Stab.Fund:$0.WW$0.12
Other Deduction Detail: SDI: 2.57
Otoniel A. Penalosa
51285 Frederick St
Coachella, CA92236
3
Landscape Inigahon
Labor
D o
a
0
o
a
a
0.00
0000.007
0.00
0.00
ass
1) 0.00
2) 0,00
a) 2,67
23.t3
244.31
0 0
a
0
0
a
a
a
0.00
0.0a 0.001s,5a
S 0
a
0
o
a
e.a0
a
g.()0
s3.43 0.�
621666061
61855
Male Hispanic American
Fringe Detail; Annuity $4.00r$0.50, Pension: $67.201$8.40, Health & Welfare: $69.761$7.47. Vacation: $38.961$4.87, Administragve Fund: $0.4840.06, Training Fund: $5.521$0.69, ConUact Compliance: $2.401$0.30, Indust.
Stab.Fund: $0.961$0.12
Other Deduction Detail: SDI: 2.67
Gerardo Saldivar Meiia
81921 Victoria St.
India, CA 92201
0
andscape Irrigation
Labor
D 0
0
a
a
a
0
a
0.00
000 o.m
133.72
17.08
5.00
0.00
3.99S)
1) 0.00
2) 0.00
2 7528.82
245.62
D±01
0
a
0
0
0
0.00
aao aao
S
n
o
0
Ono
q
4.00
33.a3 0.00
60706aO60
275.44
61830
Male Hispanic American
rnnge Detail: Administrative Funo: $U.Z41$0.06, Pension: $33.60158.40, Annulty: $2.001$0.50, Vacation: $19.481$4.87, Contract Compliance: $1.201$0.30, Indust. Stab.Fund: $0.481$0.12, Health & Welfare: $29.88f$7.47,
Training Fund, $2.761$0.69
Other Deduction Detail: SDI: 2.75
While compietion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
% 3.3. 5,5(a). The Copeland Act (40 US.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of f abor {DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis -Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
PAYROLL
(For Contractor's Optional Use; See Instructions, 1=orrn WH-347 Inst.)
NAME OF CONTRACTOR � OR SUBCONTRACTOR Wage CA-SC_UH
ADDRESS Pp $ox 1177
Urban Habitat Det:
La Quinta, CA 92247
PAYROLL NO.
FOR WEEK ENI)MG
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
11.0
12/28=19
La Quinta Silver -Rock Park Venue
2016.08/20 t 6-08
La Quinta SilverRock Resort
(1}
(2)
(3)
(4) DAY AND UATE
(5)
(6)
(7)
(8) • Other Deductions - i) Local Tax 1
(Sy
O w
DEDUCTIONS 2) Local Tax 2
F SUN
MON
TUE
WE THII
FRI
I SAT
9 o
3) ether Deductions
NET
NAME. ADDRESS. AND
n oz a
WORK
GRO55
WAGES
PAl D
O
22
�'
23
24
25 26127128
wlTr+-
HOLDIN
TOTAL
Idenlificetion Number
o
CLASSIFICATION
7tlTAL
RATE
AMOUNT
FOR WEEK!
FLOURS WORKED EACH DAY
OF EMPLOYEE
z
HOURS
OF PAY
EARNED
FICA
TAX
SWH
Medicare
OTHER'
DEDUCTIONS
Check No.
Sax Rats
Gerardo Saldivar Mejia
andscape Irrigation
O 0
0
0
0
0
0
0
0.00
00o ODDX275.44
1) 0.00
81921 Victoria St.
0
abor
2) 0.00
Indio, CA 922U1
0
0
0
0
a0.00
000 0.0017.DB
5.00
0.00
3,99
3) 2.75607068060
28.82
246.62
Es.,
0
0
0
0
a.ao
0
4.QQ
3593 0,00
61830
Male Hisnaric American
rnnge uetaa: Haminrstraeve rvnu: yu.z4ray.uo, rension: aaatsuf$a.4u, Annuity: wmun U.SU, vacation: $18.48/$4.d7, Contract Compiiancer $1.201$0.30, Indust. Stab.Fund: $U.4ar$U.12. Health & Welfare: $29.88/$7A7,
Training Fund: $2.76t$0.69
Other Deduction Detail: SDI: 2.75
Rafael Sanchez Garcia
56725 Harrison St,
Thermal, CA 92274
0
Lands cape Irr. Tender
D o
a
0
0
0
0
a
0.00
0.00 000
136.00
8.43
09fl
0.00
3.97
2) 000
3) 1.36
11.76
124,24
0 0
o
a
o
3
o
0
0,00
O.on 0,00
S o
0
0
o
a
goo
0
8,00
tz0o 0,00
61412687a
138.00
61859
Male HisDanic American
rringe vetaa: rteaitn a, vvenate: y 1H.our4t[.4o, rensrom ws.uunfi.uu, vacation: Z85.24r$1 .U3, Annuity: $2.Ou1$u.2b
Other Deduction Detail: SDI: 1.36
While compietion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3. 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "fumish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(ei)(3)10) require ctmtmdws to submit weekly a copy of al payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indfcating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis -Bacon prevai1ng wage rate for the work performed,
DOL and federal contracting agencies receiving this information review the information 10 determine that employees have received legally requited wages and fringe benefits.
Date January 16th, 2020
i, Theresa Brennan President
(Name of Signatory Party) (Title)
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
Urban Habitat on the
(Contractor or Subcontractor)
La Quinta SiiverRock Park Venue a Public Works Project commencing on the
(Building or Work)
22nd day of December , 2019 , and ending the 28th day of December 2019
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have been or will be made either directly or indirectly to or no behalf of said
Urban Habitat
(Contractor or Subcontractor)
from 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 as defined in Regulations, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, SDI, State Tax
Lien
(2) That the payrolls for the Public Works Project required to be submitted are true, correct and
complete, that the wage rates for Laborers and Mechanics contained therein are not less than the
applicable wage rates contained in any wage determination assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the
above referenced payroll, payments of fringe benefits as listed in the contract have been
or will be made to appropriate programs for the benefit of such employees, except as
noted in section 4(c) below,
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
❑ Each laborer or mechanic listed in the above referenced payroll has been paid, as
indicated on the payroll, an amount not less than the sum of the applicable basic
hourly wage rate plus the amount of the required fringe benefits as #fisted in the
contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 1 0101119,Pay roll #11, Contractor
License # 963744, Workers Compensation Policy # URWC004126
NAME AND TITLE' SIGNATURE.
Theresa Brennan, President Signed Electronically
THE WILLFUL FALSIFICATfON OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE iB AND SECTION 231 OF TITLE
31 OF THE UNITED STATES CODE.
U.S. G RQ.- 1997 519 W
eCPR Online Confirmation
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: URBAN HABITAT
Contractor Address: 36953 COOK ST., STE. 101 PALM DESERT CA 92211
Awarding Body: THE CITY OF LA QUINTA
Project ID: 300347
Contract With: THE CITY OF LA QUINTA
Week Ending Date: 2019-12-28
Payroll Number: 11
Amendment Number: 0
18 employee payroll record(s) processed
Your Transaction ID is: 7444179
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