A redacted sample of the output we deliver. Downloadable PDF (WH-347) plus XML (DIR eCPR) for California public-works jobs.
Redacted sample for a California curb-and-gutter subcontractor, week ending 10/10/2026.
U.S. DEPARTMENT OF LABOR Form WH-347 Page 1 of 1
PAYROLL (For Contractor's Optional Use)
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NAME OF CONTRACTOR: [Redacted] Concrete Construction Inc.
ADDRESS: [Redacted], Culver City, CA 90230
PAYROLL NO.: 12 FOR WEEK ENDING: 10/10/2026
PROJECT AND LOCATION: Culver City Sidewalk Phase 2 (Culver City, CA)
PROJECT OR CONTRACT NO.: 24-0421 DIR PROJECT ID: 100000000X
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Name & Last 4 Class Hrs ST Hrs OT Rate ($) Fringe($) Gross
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Jose P. #4421 Cement Mason 40 1 $47.52 $31.28 $2,428.80
Maria R. #9910 Cement Mason 40 0 $47.52 $31.28 $3,152.00
Carlos N. #0027 CMason Apprentc 32 0 $35.64 $23.46 $1,891.20
Luis M. #4487 Laborer Group 1 40 2 $38.11 $24.80 $2,769.42
Sofia D. #1200 Laborer Group 1 32 0 $38.11 $24.80 $2,013.12
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STATEMENT OF COMPLIANCE
I, [Name], (title) [Owner], do hereby state:
(1) That I pay or supervise the payment of the persons employed by [Contractor]
on the (building or work) Culver City Sidewalk Phase 2;
(2) that during the payroll period commencing on the 4th day of October 2026,
and ending on the 10th day of October 2026, all persons employed on said
project have been paid the full weekly wages earned...
Signature: ___________________
Date: ___________________
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The XML we deliver uploads directly into the DIR eCPR system.
<eCPR xmlns="http://www.dir.ca.gov/dlse/ecpr" version="2.0">
<ContractorInfo>
<LegalBusinessName>[Redacted] Concrete Construction Inc.</LegalBusinessName>
<DIRRegistrationNumber>1000000012</DIRRegistrationNumber>
<LicenseNumber>1234567</LicenseNumber>
</ContractorInfo>
<ProjectInfo>
<DIRProjectID>100000000X</DIRProjectID>
<AwardingBody>City of Culver City</AwardingBody>
<PrimeContractor>[Prime Co]</PrimeContractor>
<ContractNumber>24-0421</ContractNumber>
</ProjectInfo>
<PayrollRecord weekEnding="2026-10-10" payrollNumber="12">
<Worker ssnLast4="4421" firstName="Jose" lastName="P"
classification="Cement Mason"
hoursStraightTime="40" hoursOvertime="1"
basePayRate="47.52" fringeRate="31.28">
<DailyHours day="Mon" straight="8" ot="0"/>
<!-- ...one row per day... -->
</Worker>
<!-- ...one block per worker... -->
</PayrollRecord>
</eCPR>