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HomeMy WebLinkAbout20230508165814585 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. NAME OF CONTRACTOR_ OR SUBCONTRACTOR_ ADDRESS 769 Pinto Circle OMB No.: White Rock Construction Inc. Gardnerville NV 89410 EXpJlres: PAYROLL NO. FOR WEEK ENDING PROJECTAND LOCATION PROJECT OR CONTRACT NO. Keller Heavenly 3 38 4/29/2023 12:00:00 AM 1275 Meadow Crest Drive South Lake Tahoe CA (1) f (2) (3) (4)DAY AND DATE (5) (6) (7) (8)DEDUCTIONS (9) Sun Mon Tue Wed Thu Fri Sat GROSS NAME AND INDIVIDUAL IDENTIFYING N0.OF AMOUNT FEDERAL STATE NET NUMBER(e.g.,LAST FOUR DIGITS OF W/H OT 23 24 25 26 271 28 29 EARNED WITH- WITH- WAGES SOCIAL SECURITY NUMBER)OF EXEMP WORK OR TOTAL RATE PROJECT HOLDING HOLDING TOTAL PAID WORKER TIONS CLASSIFICATION ST HOURS WORKED EACH DAY HOURS OF PAY /PERIOD FICA TAX TAX MEDICARE OTHER` DEDUCTIONS FOR WEEK Eduardo A Acevedo 1 1000 0 0.50 1.00 0.50 0.50 2.50 79.80 _2,691.09 PO Box 425 GL3 S 8.00 8.00 8.00 8.00 8.00 40.00 62.29 2,691.09 166.85 455.02 187.50 39.02 24,22 872.61 1,818.48 Rincon PR 00677 Dwight E Bolton 1 1000 0 _ 355.60 759 Hornet Drive CSO S 2.00 2.25 4.25 83.67 3,982.17 246.89 578.40 245.32 57.74 34.83 1,163.18 2,818.99 Gardnerville NV 89460 Dwight E Bolton 1 1000 0 431.30 L0928 S 3.00 2.00 5.00 86.26 Dwight E Bolton 1 1000 0 2.00 4.25 3.00 1.50 10.75 88.20 3,082.77 T3 S 8.00 6.00 5.75 5.00 6.00 30.75 69.42 German Franco 1 1000 0 1.00 1.00 0.50 2.50 115.10 3,092.23 _ 1080 Centerville Road EX3 S 8.00 8.00 8.00 1 8.00 32.00 1 87.64 3,838.82 238.01 886.27 236.24 55.66 34,55 1,450.73 2,388.09 Gardnerville NV 89460 German Franco 1 1000 0 0.50 0.50 113.02 746.59 L0928 S 8.00 8.00 86.26 Richard A Jacobson 1 1000 0 _ _25_1_._01 P.O.Box 8720 CSO S 3.00 3.00 83.67 3,091.33 191.66 551.07 234.37 44.82 27.82 1,049.74 2,041.59 South Lake Tahoe CA 96158 Richard A Jacobson 1 1000 0 175.28 EX3 S 2.00 2.00 87.64 Richard A Jacobson 1 1000 0 0.50 0.50 0.50 1.50 79.80 524.59 GL3 S 2.00 3.00 1.50 6.50 62.29 Richard A Jacobson 1 1000 0 603.82 L0928 S 3.00 3.00 1.00 7.00 86.26 Richard A Jacobson 1 1000 0 0.50 0.501 88.20 1,536.63 T3 S 1 5.00 3.00 6.50 7.00 21.501 69.42 Alejandro C Martinez 1 1000 0 _ 167.34 P.O.Box 13063 C50 S 2.00 2.00 83.67 2,600.52 161.23 337.13 184.16 37.71 23.40 743.63 1,856.89 South lake Tahoe CA 96151 Alejandro C Martinez 1 1000 0 0.50 1.001 0.50 1 2.00 79.80 2,433.18 -------- GL3 S 8.001 8.001 6.50 6.00 8.00 36.50 62.29 Leslie McCroskv 0 1000 0 1.00 1.50 0.50 1.00 4.00 115.10 _3,834_._53 897 Si)rinq Valley Road EX3 S 8.00 8.00 6.50 8.00 8.00 38.50 87.64 3,834.53 237.74 600.50 244.69 55.60 34.51 1,173.04 2,661.49 Gardnerville NV 89410 Richard R Nieves Sanchez 1 1000 0 0.50 1.00 0.50 0.50 2.50 79.801 2_,69_1_,009 HC57 Box 9042 GL3 S 8.00 8.00 8.00 8.00 8.001 40.00 62. 99 2,691.09 1 166.85 455.02 193.43 39.02 24.22 878.54 1,812.55