2025-03 - Phase Ia Devcon LaborPAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DEVCON Construction, Inc.
CONTRACTOR'S LICENSE NO: 399163
SPECIALITY LICENSE NO:
ADDRESS
690 Gibraltar Dr. , MILPITAS, CA 95035
PAYROLL NO.
7
FOR WEEK ENDING
03/07/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: WA266D066455019
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.
/DateSatSunMonTueWedThuFri
01 02 03 04 05 06 07
HOURS WORKED EACH DAY
Serafin Jimenez
Diosdado
94 MCCREERY AVENUE,
APT B
SAN JOSE, CA 95116
xxx-xx-6788
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,233.46 9418252
03/12/2025O
125.50 79.99 41.37 19.68 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 406.94
Jose A Rodriguez
6623 BROOK FALLS
CIRCLE
STOCKTON, CA 95219
xxx-xx-3430
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 44.76 1,790.40
1,790.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,159.82 110346
03/12/2025O
136.97 232.62 99.11 21.48 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 630.58
Fernando Romero
10091 TORRANCE
AVENUE
SAN JOSE, CA 95127
xxx-xx-5270
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,071.43 9418283
03/12/2025O
125.49 199.62 83.77 19.69 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 568.97
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 3
PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DEVCON Construction, Inc.
CONTRACTOR'S LICENSE NO: 399163
SPECIALITY LICENSE NO:
ADDRESS
690 Gibraltar Dr. , MILPITAS, CA 95035
PAYROLL NO.
7
FOR WEEK ENDING
03/07/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: WA266D066455019
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.
/DateSatSunMonTueWedThuFri
01 02 03 04 05 06 07
HOURS WORKED EACH DAY
Serafin Jimenez
Diosdado
94 MCCREERY AVENUE,
APT B
SAN JOSE, CA 95116
xxx-xx-6788
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,233.46 9418252
03/12/2025O
125.50 79.99 41.37 19.68 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 406.94
Jose A Rodriguez
6623 BROOK FALLS
CIRCLE
STOCKTON, CA 95219
xxx-xx-3430
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 44.76 1,790.40
1,790.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,159.82 110346
03/12/2025O
136.97 232.62 99.11 21.48 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 630.58
Fernando Romero
10091 TORRANCE
AVENUE
SAN JOSE, CA 95127
xxx-xx-5270
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,071.43 9418283
03/12/2025O
125.49 199.62 83.77 19.69 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 568.97
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 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/19/2025
Christina Santos Payroll Clerk 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
DEVCON Construction, Inc.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 1st day of March 2025 , and ending the 7th 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
DEVCON Construction, Inc. 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:
FICA, FED, ST, SDI, & VAC
(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
Christina Santos
Payroll Clerk
03/19/2025 09:58:54
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 3
Other deductions:
Worker Name WORK CLASSIFICATION DUES/VACATION
Serafin Jimenez Diosdado J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Fernando Romero J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Jose A Rodriguez J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Printed Date: 4/13/2025 Page 3 of 3
PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DEVCON Construction, Inc.
CONTRACTOR'S LICENSE NO: 399163
SPECIALITY LICENSE NO:
ADDRESS
690 Gibraltar Dr. , MILPITAS, CA 95035
PAYROLL NO.
8
FOR WEEK ENDING
03/14/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: WA266D066455019
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.
/DateSatSunMonTueWedThuFri
08 09 10 11 12 13 14
HOURS WORKED EACH DAY
Serafin Jimenez
Diosdado
94 MCCREERY AVENUE,
APT B
SAN JOSE, CA 95116
xxx-xx-6788
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 41.01 1,312.32
1,312.32
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,016.31 9431737
03/19/2025O
100.39 40.62 26.93 15.75 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 112.32 296.01
Jose A Rodriguez
6623 BROOK FALLS
CIRCLE
STOCKTON, CA 95219
xxx-xx-3430
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 44.76 1,790.40
1,790.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,159.82 120349
03/19/2025O
136.96 232.62 99.11 21.49 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 630.58
Fernando Romero
10091 TORRANCE
AVENUE
SAN JOSE, CA 95127
xxx-xx-5270
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 41.01 1,312.32
1,312.32
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
904.03 9431765
03/19/2025O
100.39 127.44 52.39 15.75 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 112.32 408.29
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 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/25/2025
Christina Santos Payroll Clerk 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
DEVCON Construction, Inc.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 8th day of March 2025 , and ending the 14th 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
DEVCON Construction, Inc. 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:
FICA, FED, ST, SDI, & VAC
(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
Christina Santos
Payroll Clerk
03/25/2025 07:52:25
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 3
Other deductions:
Worker Name WORK CLASSIFICATION DUES/VACATION
Serafin Jimenez Diosdado J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)112.32
Fernando Romero J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)112.32
Jose A Rodriguez J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Printed Date: 4/13/2025 Page 3 of 3
PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DEVCON Construction, Inc.
CONTRACTOR'S LICENSE NO: 399163
SPECIALITY LICENSE NO:
ADDRESS
690 Gibraltar Dr. , MILPITAS, CA 95035
PAYROLL NO.
9
FOR WEEK ENDING
03/21/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: WA266D066455019
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.
/DateSatSunMonTueWedThuFri
15 16 17 18 19 20 21
HOURS WORKED EACH DAY
Serafin Jimenez
Diosdado
94 MCCREERY AVENUE,
APT B
SAN JOSE, CA 95116
xxx-xx-6788
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 4.00 8.00 8.00 8.00 8.00 36.00 41.01 1,476.36
1,476.36
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,124.87 9443206
03/26/2025O
112.95 60.30 34.16 17.72 3.51 126.36 10.60 381.60 10.46 376.56
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 18.72 4.82 173.52 126.36 351.49
Jose A Rodriguez
6623 BROOK FALLS
CIRCLE
STOCKTON, CA 95219
xxx-xx-3430
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 4.00 8.00 8.00 8.00 8.00 36.00 44.76 1,611.36
1,611.36
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,068.36 130344
03/26/2025O
123.28 193.23 80.80 19.33 3.51 126.36 10.60 381.60 10.46 376.56
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 18.72 4.82 173.52 126.36 543.00
Fernando Romero
10091 TORRANCE
AVENUE
SAN JOSE, CA 95127
xxx-xx-5270
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 4.00 4.00 8.00 8.00 24.00 41.01 984.24
984.24
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
706.16 9443235
03/26/2025O
75.29 78.90 27.84 11.81 3.51 84.24 10.60 254.40 10.46 251.04
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 12.48 4.82 115.68 84.24 278.08
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 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 4/1/2025
Christina Santos Payroll Clerk 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
DEVCON Construction, Inc.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 15th day of March 2025 , and ending the 21st 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
DEVCON Construction, Inc. 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:
FICA, FED, ST, SDI, & VAC
(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
Christina Santos
Payroll Clerk
04/01/2025 14:58:24
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 3
Other deductions:
Worker Name WORK CLASSIFICATION DUES/VACATION
Serafin Jimenez Diosdado J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)126.36
Fernando Romero J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)84.24
Jose A Rodriguez J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)126.36
Printed Date: 4/13/2025 Page 3 of 3
PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
DEVCON Construction, Inc.
CONTRACTOR'S LICENSE NO: 399163
SPECIALITY LICENSE NO:
ADDRESS
690 Gibraltar Dr. , MILPITAS, CA 95035
PAYROLL NO.
10
FOR WEEK ENDING
03/28/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: WA266D066455019
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.
/DateSatSunMonTueWedThuFri
22 23 24 25 26 27 28
HOURS WORKED EACH DAY
Serafin Jimenez
Diosdado
94 MCCREERY AVENUE,
APT B
SAN JOSE, CA 95116
xxx-xx-6788
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,233.48 9454368
04/02/2025O
125.48 79.99 41.37 19.68 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 406.92
Fernando Romero
10091 TORRANCE
AVENUE
SAN JOSE, CA 95127
xxx-xx-5270
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 8.00 40.00 41.01 1,640.40
1,640.40
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,071.43 9454401
04/02/2025O
125.50 199.62 83.77 19.68 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 140.40 568.97
Jaime A Ruiz
2209 KIMES RANCH
ROAD
PATTERSON, CA 95363
xxx-xx-0082
S/0
CA 2024-1
Journeyman
Santa Clara
Carpenter
Carpenter (Area 1)
S 8.00 8.00 69.90 559.20
3,052.04
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,916.20 9454325
04/02/2025O
233.48 457.65 172.48 36.63 5.89 47.12 12.87 102.96 11.40 91.20
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.26 10.08 3.59 28.72 235.60 1,135.84
Gabriel Topete
630 ELEVENTH AVENUE
WEST MENLO PARK, CA
94025
xxx-xx-9562
S/0
CA 2024-1
Journeyman
Santa Clara
Carpenter
Carpenter (Area 1)
S 8.00 8.00 69.90 559.20
1,398.00
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
950.25 9454330
04/02/2025O
106.95 146.29 59.93 16.78 5.89 47.12 12.87 102.96 11.40 91.20
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.26 10.08 3.59 28.72 117.80 447.75
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
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 4/7/2025
Christina Santos Payroll Clerk 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
DEVCON Construction, Inc.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 22nd day of March 2025 , and ending the 28th 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
DEVCON Construction, Inc. 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:
FICA, FED, ST, SDI, & VAC
(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
Christina Santos
Payroll Clerk
04/07/2025 14:23:35
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 3
Other deductions:
Worker Name WORK CLASSIFICATION DUES/VACATION
Jaime A Ruiz J Carpenter / Carpenter (Area 1) (Santa Clara)235.60
Gabriel Topete J Carpenter / Carpenter (Area 1) (Santa Clara)117.80
Serafin Jimenez Diosdado J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Fernando Romero J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Printed Date: 4/13/2025 Page 3 of 3
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/19/2025
Christina Santos Payroll Clerk 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
DEVCON Construction, Inc.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 1st day of March 2025 , and ending the 7th 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
DEVCON Construction, Inc. 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:
FICA, FED, ST, SDI, & VAC
(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
Christina Santos
Payroll Clerk
03/19/2025 09:58:54
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 3
Other deductions:
Worker Name WORK CLASSIFICATION DUES/VACATION
Serafin Jimenez Diosdado J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Fernando Romero J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Jose A Rodriguez J Laborer And Related Classifications / Group 3; Group 3 (A) (Area 1) (Santa Clara)140.40
Printed Date: 4/13/2025 Page 3 of 3