2025-03 - Phase Ia Desilva Gates LaborPAYROLL REPORTING FORM Page 1 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
DESILVA GATES CONSTRUCTION
CONTRACTOR'S LICENSE NO: 704195
SPECIALITY LICENSE NO:
ADDRESS
11555 Dublin Blvd, DUBLIN, CA 94568
PAYROLL NO.
6
FOR WEEK ENDING
03/08/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: 7409465
PROJECT OR CONTRACT NO: 20240543108
PROJECT AND LOCATION: The Rise at Vallco Horizontal Ph1A / 10123 N Wolfe
Rd, Cupertino, CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateSunMonTueWedThuFriSat
02 03 04 05 06 07 08
HOURS WORKED EACH DAY
Leslie Buckett
48005 MINES ROAD
LIVERMORE, CA 94550
xxx-xx-0039
S/4
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 3 (Area 1)
S 8.00 8.00 67.17 537.36
1,074.72
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
737.77 484733
03/14/2025O
82.21 111.55 33.81 12.90 6.03 48.24 13.38 107.04 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 1.60 12.80 96.48 336.95
Ruben De La Cruz
25387 MOHR DR.
HAYWARD, CA 94545
xxx-xx-7674
S/4
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Construction Specialist
(Area 1)
S 8.00 8.00 16.00 45.04 720.64
1,080.96
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
785.77 484764
03/14/2025O
82.68 81.08 34.22 12.97 3.51 56.16 10.60 169.60 14.96 239.36
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 8.32 0.32 5.12 84.24 295.19
Roberto Lemos
618 C STREET
LOS BANOS, CA 93635
xxx-xx-3662
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 8.00 8.00 16.00 65.79 1,052.64
1,052.64
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
792.36 484855
03/14/2025O
80.52 38.30 32.35 12.63 6.03 96.48 13.38 214.08 11.28 180.48
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 19.36 1.60 25.60 96.48 260.28
Austin Mc Crory
738 HATTAN DR.
LIVERMORE, CA 94551
xxx-xx-9585
S/4
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 2 (Area 1)
S 8.00 8.00 16.00 71.65 1,146.40
3,022.70
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,813.40 484882
03/14/2025O
231.24 478.97 212.57 36.27 6.03 96.48 13.38 214.08 11.28 180.48
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 19.36 1.60 25.60 250.25 1,209.30
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 1 of 3
PAYROLL REPORTING FORM Page 2 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
DESILVA GATES CONSTRUCTION
CONTRACTOR'S LICENSE NO: 704195
SPECIALITY LICENSE NO:
ADDRESS
11555 Dublin Blvd, DUBLIN, CA 94568
PAYROLL NO.
6
FOR WEEK ENDING
03/08/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: 7409465
PROJECT OR CONTRACT NO: 20240543108
PROJECT AND LOCATION: The Rise at Vallco Horizontal Ph1A / 10123 N Wolfe
Rd, Cupertino, CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateSunMonTueWedThuFriSat
02 03 04 05 06 07 08
HOURS WORKED EACH DAY
John Pipkin
1652 DANIELS AVE.
ESCALON, CA 95320
xxx-xx-6093
S/99
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 8.00 8.00 65.79 526.32
526.32
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
202.27 484941
03/14/2025O
40.27 6.32 6.03 48.24 13.38 107.04 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 1.60 12.80 277.46 324.05
Brian Spini
917 RUBY ST.
REDWOOD CITY, CA
94061
xxx-xx-0296
S/0
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 1 (Area 1)
S 8.00 8.00 16.00 70.18 1,327.40
2,450.28
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,440.82 484993
03/14/2025O1.00 1.00 2.00 102.26
187.45 420.97 166.62 29.40 6.03 108.54 13.38 240.84 11.28 203.04
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 21.78 1.60 28.80 205.02 1,009.46
Miguel Zendejas Tapia
29342 RUUS RD
HAYWARD, CA 94544
xxx-xx-9180
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 8.00 8.00 65.79 526.32
526.32
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
424.54 431
03/14/2025O
40.26 6.96 6.32 6.03 48.24 13.38 107.04 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 1.60 12.80 48.24 101.78
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 2 of 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/14/2025
Balvinder Chand Labor Compliance Specialist do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
DESILVA GATES CONSTRUCTION on the The Rise at Vallco Horizontal Ph1A
(Contract/Subcontract: 20240543108) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 2nd day of March 2025 , and ending the 8th day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
DESILVA GATES CONSTRUCTION from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as described
below:
(2) That any payrolls otherwise under this contract 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice and Training, United States Department of Labor.
(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 listed in the contract, except as noted in Section
4(c) below.
(c) EXCEPTIONS
Exception (craft)EXPLANATION
REMARKS:
NAME AND TITLE SIGNATURE
Balvinder Chand
Labor Compliance Specialist
03/14/2025 11:55:46
THE WILLFUL FALSIFICATION 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
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 3 of 3
PAYROLL REPORTING FORM Page 1 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
DESILVA GATES CONSTRUCTION
CONTRACTOR'S LICENSE NO: 704195
SPECIALITY LICENSE NO:
ADDRESS
11555 Dublin Blvd, DUBLIN, CA 94568
PAYROLL NO.
7
FOR WEEK ENDING
03/15/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: 7409465
PROJECT OR CONTRACT NO: 20240543108
PROJECT AND LOCATION: The Rise at Vallco Horizontal Ph1A / 10123 N Wolfe
Rd, Cupertino, CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateSunMonTueWedThuFriSat
09 10 11 12 13 14 15
HOURS WORKED EACH DAY
Leslie Buckett
48005 MINES ROAD
LIVERMORE, CA 94550
xxx-xx-0039
S/4
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 3 (Area 1)
S 8.00 8.00 16.00 67.17 1,074.72
1,074.72
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
737.75 485286
03/21/2025O
82.23 111.55 33.81 12.90 6.03 96.48 13.38 214.08 11.28 180.48
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 19.36 1.60 25.60 96.48 336.97
Ruben De La Cruz
25387 MOHR DR.
HAYWARD, CA 94545
xxx-xx-7674
S/4
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Construction Specialist
(Area 1)
S 8.00 8.00 16.00 45.04 720.64
720.64
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
547.56 485312
03/21/2025O
55.13 39.18 13.96 8.65 3.51 56.16 10.60 169.60 14.96 239.36
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 8.32 0.32 5.12 56.16 173.08
Austin Mc Crory
738 HATTAN DR.
LIVERMORE, CA 94551
xxx-xx-9585
S/4
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 2 (Area 1)
S 8.00 8.00 16.00 71.65 1,146.40
1,146.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
844.01 485404
03/21/2025O
87.70 78.52 25.93 13.76 6.03 96.48 13.38 214.08 11.28 180.48
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 19.36 1.60 25.60 96.48 302.39
Matthew Medina
14160 LESLEY LN.
SAN MARTIN, CA 95046
xxx-xx-7416
S/9
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 3 (Area 1)
S 8.00 8.00 16.00 67.17 1,221.33
1,221.34
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
953.80 485408
03/21/2025O1.50 1.50 97.74
93.44 37.90 16.01 14.66 6.03 105.53 13.38 234.15 11.28 197.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 21.18 1.60 28.00 105.53 267.54
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 1 of 3
PAYROLL REPORTING FORM Page 2 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
DESILVA GATES CONSTRUCTION
CONTRACTOR'S LICENSE NO: 704195
SPECIALITY LICENSE NO:
ADDRESS
11555 Dublin Blvd, DUBLIN, CA 94568
PAYROLL NO.
7
FOR WEEK ENDING
03/15/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: 7409465
PROJECT OR CONTRACT NO: 20240543108
PROJECT AND LOCATION: The Rise at Vallco Horizontal Ph1A / 10123 N Wolfe
Rd, Cupertino, CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateSunMonTueWedThuFriSat
09 10 11 12 13 14 15
HOURS WORKED EACH DAY
Leobardo Ontiveros-
mejia
LEOBARDO 1345
INGLEWOOD ST.
HAYWARD, CA 94544
xxx-xx-5179
CA 2024-1
Apprentice
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Operating Engineer
(Heavy And Highway
Work) (Area 1)
Period 5
S 8.00 8.00 16.00 62.33
997.28
997.28
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
711.37 485441
03/21/2025
O
76.29 80.47 28.70 11.97 5.53 88.48 13.38 214.08 9.68 154.88
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 2.21 35.36 1.60 25.60 88.48 285.91
Brian Spini
917 RUBY ST.
REDWOOD CITY, CA
94061
xxx-xx-0296
S/0
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 1 (Area 1)
S 8.00 8.00 16.00 70.18 1,378.53
1,378.52
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
908.36 485495
03/21/2025O2.00 0.50 2.50 102.26
105.46 178.39 58.21 16.54 6.03 111.56 13.38 247.53 11.28 208.68
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 22.39 1.60 29.60 111.56 470.16
Miguel Zendejas Tapia
29342 RUUS RD
HAYWARD, CA 94544
xxx-xx-9180
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 8.00 8.00 16.00 65.79 1,052.64
1,052.64
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
782.74 490130
03/21/2025O
80.53 47.91 32.35 12.63 6.03 96.48 13.38 214.08 11.28 180.48
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 19.36 1.60 25.60 96.48 269.90
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 2 of 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/20/2025
Balvinder Chand Labor Compliance Specialist do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
DESILVA GATES CONSTRUCTION on the The Rise at Vallco Horizontal Ph1A
(Contract/Subcontract: 20240543108) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 9th day of March 2025 , and ending the 15th day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
DESILVA GATES CONSTRUCTION from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as described
below:
(2) That any payrolls otherwise under this contract 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice and Training, United States Department of Labor.
(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 listed in the contract, except as noted in Section
4(c) below.
(c) EXCEPTIONS
Exception (craft)EXPLANATION
REMARKS:
NAME AND TITLE SIGNATURE
Balvinder Chand
Labor Compliance Specialist
03/20/2025 16:05:38
THE WILLFUL FALSIFICATION 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
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 3 of 3
PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DESILVA GATES CONSTRUCTION
CONTRACTOR'S LICENSE NO: 704195
SPECIALITY LICENSE NO:
ADDRESS
11555 Dublin Blvd, DUBLIN, CA 94568
PAYROLL NO.
8
FOR WEEK ENDING
03/22/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: 7409465
PROJECT OR CONTRACT NO: 20240543108
PROJECT AND LOCATION: The Rise at Vallco Horizontal Ph1A / 10123 N Wolfe
Rd, Cupertino, CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateSunMonTueWedThuFriSat
16 17 18 19 20 21 22
HOURS WORKED EACH DAY
Brian Spini
917 RUBY ST.
REDWOOD CITY, CA
94061
xxx-xx-0296
S/0
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 1 (Area 1)
S 8.00 8.00 70.18 561.44
1,684.32
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,056.61 486029
03/28/2025O
128.85 245.67 88.26 20.21 6.03 48.24 13.38 107.04 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 1.60 12.80 144.72 627.71
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 1 of 2
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/31/2025
Balvinder Chand Labor Compliance Specialist do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
DESILVA GATES CONSTRUCTION on the The Rise at Vallco Horizontal Ph1A
(Contract/Subcontract: 20240543108) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 16th day of March 2025 , and ending the 22nd day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
DESILVA GATES CONSTRUCTION from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as described
below:
(2) That any payrolls otherwise under this contract 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice and Training, United States Department of Labor.
(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 listed in the contract, except as noted in Section
4(c) below.
(c) EXCEPTIONS
Exception (craft)EXPLANATION
REMARKS:
NAME AND TITLE SIGNATURE
Balvinder Chand
Labor Compliance Specialist
03/31/2025 14:06:30
THE WILLFUL FALSIFICATION 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
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 2 of 2