| (1) Name and individual identifying number of worker | (2) No. of withholding exemptions | (3) Work classification | (4) Day and date — hours worked each day | (5) Total hours | (6) Rate of pay incl. fringe | (7) Gross amount earned | (8) Deductions | (9) Net wages paid for week | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Su 8/31 | M 9/1 | Tu 9/2 | W 9/3 | Th 9/4 | F 9/5 | Sa 9/6 | FICA | Fed W/H | State | Other | |||||||
| Rivera, Marco XXX-XX-4821 | 2 | Sheet Metal Worker | — | 8 | 8 | 8 | 8 | 8 | — | 40.0 S | $52.14 | $2,085.60 | $159.55 | $231.00 | $88.40 | $0.00 | $1,606.65 |
| Okafor, James XXX-XX-0377 | 1 | Sheet Metal Worker | — | 8 | 8 | 8/2 | 8 | 8 | — | 40.0 S 2.0 O | $52.14 $78.21 | $2,242.02 | $171.51 | $248.00 | $96.10 | $0.00 | $1,726.41 |
| Nguyen, Thao XXX-XX-9150 | 0 | Pipefitter | — | 8 | 8 | 8 | 8 | 6 | — | 38.0 S | $58.90 | $2,238.20 | $171.22 | $252.00 | $95.80 | $0.00 | $1,719.18 |
| Brooks, Devon XXX-XX-2264 | 1 | Apprentice SMW, 3rd period (60%) | — | 8 | 8 | 8 | 8 | 8 | — | 40.0 S | $36.50 | $1,460.00 | $111.69 | $142.00 | $51.20 | $0.00 | $1,155.11 |
| Castillo, Ana XXX-XX-7708 | 3 | Laborer, Group 1 | — | 8 | 8 | 8 | 8 | 6.5 | — | 38.5 S | $41.20 | $1,586.20 | $121.34 | $161.00 | $58.90 | $0.00 | $1,244.96 |
| Patel, Kiran XXX-XX-5539 | 2 | Pipefitter | — | 8 | 8 | 8 | 8 | 4 | — | 36.0 S | $58.90 | $2,120.40 | $162.21 | $236.00 | $90.60 | $0.00 | $1,631.59 |
Date: 09/08/2026 I, Marco Rivera, Owner, do hereby state: (1) That I pay or supervise the payment of the persons employed by Rivera Mechanical LLC on the Lincoln Elementary — HVAC replacement; that during the payroll period commencing on the 31st day of August, 2026, and ending the 6th day of September, 2026, all persons employed on said project have been paid the full weekly wages earned…
(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. ☐ (b) Where fringe benefits are paid in cash.
(c) Exceptions: Brooks, Devon — apprentice, registered CA DAS #A-118273, ratio 1:3.
<eCPR xmlns="http://www.dir.ca.gov/ecpr" version="2.1">
<Contractor name="Rivera Mechanical LLC" license="C20-1087645" pwcr="1000012345"/>
<Project dirId="452311" name="Lincoln Elementary HVAC" awardingBody="LAUSD"/>
<Payroll number="14" weekEnding="2026-09-06" statementOfCompliance="true">
<Employee lastFour="4821" classification="Sheet Metal Worker" craft="SMW">
<Hours date="2026-09-01" straight="8" overtime="0" double="0"/> …
<Pay rate="52.14" gross="2085.60" fringeToPlan="18.42" net="1606.65"/>