eceived Event (Event Succeeded) REC EV EO ee 11:46 AM 2/22/2005 Time: 6 Duration: 2 min 20 sec 8504146749 Company: Ruthiort @2/22/2085 11:44 8504146749 DBPR OGA PAGE 63/06 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION a “rf, Petitioner, OD - é 5 G of vs. SICILY PIZZA License No. 7406129 Respondent. License Type 2010 Permanent Food Service ! Case No. 2004035798 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitloner’), files this Administrative Complaint against SICILY PIZZA, ("Respondent’), and says: 4. Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service estabiishments, pursuant to Section 20.165 and Chapter 509, Florida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 00020 S ATLANTIC AVE #B, DAYTONA BCH, FLORIDA 32118.The mailing address of record is SICILY PIZZA, at 00020 S ATLANTIC AVE #B, DAYTONA BCH, FLORIDA 32118, 3, tnspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment, The violation(s) found and applicable law are described in Exhibit “A,” attached hereto and incorporated herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties; administrative fine not to exceed $1,000 per offense; mandatory attendance at Respondent's expense at an educational program sponsored by the Department's Hospitality Education Program; suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other ralief authorized by Chapter 509, Florida Statutes, or the rules promuigated thereto. Signed July 07, 2004 Uk Valerie Freeman, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No, 0153834 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of, , 2004. Received by:, Inspectors Signature Operator's Signature Title Title Case No. 2004035796 Form reviead 6/16/04 License Type: 2010 Permanent Food Service District No, 04 SICILY PIZZA License No. 7406129 Received Event (Event Succeeded) Date: Pages: Sender: Fav Number: T « 2/22/2005 Time: 11:46 AM 6 Duration: 2 min 20 sec 8504146749 Company: Suhiact- @2/22/2885 1:44 8504146749 DBPR OGA PAGE 04/06 License Number: 7406129 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004035796 Exhibit A “FC” as cited herein references specific provisions of the 1999 Food Cade, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Cade. “NFPA” as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 44-3, "Fire Prevention, Genera! Provisions”, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. Itis alleged that on May 13, 2004 and June 15, 2004 the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC), in the following particulars. Copy(s) of the report(s) for the abave referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. 4. 32-04 §09.221(2)(A) FS EACH PUBLIC FOOD SERVICE ESTABLISHMENT BATHROOM SHALL BE PROPERLY DESIGNATED. THE MEN'S RESTROOM WAS NOT IDENTIFIED BY SIGNAGE. 2, 36-03 6-303,11(A) FC INTENSITY. THE LIGHT INTENSITY SHALL BE: (A) AT LEAST ...(10 FOOT- CANDLES) AT.A DISTANCE OF ...(30 INCHES) ABOVE THE FLOOR, IN WALK-IN REFRIGERATION UNITS AND DRY FOOD STORAGE AREAS AND IN OTHER AREAS AND ROOMS DURING PERIODS OF CLEANING; THERE WAS NOT AT LEAST TEN FOOT CANDLE OF LIGHT THIRTY INCHES FROM THE FLOOR OF THE WALK-IN REFRIGERATION UNIT. * 3,46-11.1 NFPA 101, 12-2.10 & 5-10.1 MEANS OF EGRESS SHALL BE MARKED IN ACCORDANCE WITH SECTION 7-10. THE EXIT LIGHT Dif? NOT PROPERLY ILLUMINATE WHEN TESTED. * 4.47-01 61C-1,004(11) FAC ELECTRICAL WIRING -- TO PREVENT FIRE OR INJURY, DEFECTIVE ELECTRICAL WIRING SHALL BE REPLACED AND WIRING SHALL BE KEPT IN GOOD REPAIR. NO EXTENSION CORDS SHALL BE USED EXCEPT DURING CLEANING, MAINTENANCE AND OTHER TEMPORARY ACTIVITIES. ONLY AWALL SWITCH OR APPROVED PULL CORD SHALL BE PERMITTED IN BATHROOMS, IN ACCORDANCE WITH THE PROVISIONS OF NFPA 70, THE NATIONAL ELECTRICAL CODE, AS ADOPTED BY THE DIVISION OF STATE FIRE MARSHAL IN CHAPTER 4A-3, FAC, UNIFORM FIRE SAFETY RULES AND STANDARDS, SUFFICIENT ELECTRICAL OUTLETS SHALL BE PROVIDED. OBSERVED EXPOSED WIRING AT THE CEILING LIGHT IN THE MEN'S RESTROOM. 5. 51-04 509.213(1)FS EVERY PUBLIC FOOD SERVICE ESTABLISHMENT SHALL POST A SIGN WHICH ILLUSTRATES AND DESCRIBES THE HEIMLICH MANEUVER PROCEDURE FOR RENDERING EMERGENCY FIRST AID TO A CHOKING VICTIM IN A CONSPICUOUS PLACE IN THE ESTABLISHMENT ACCESSIBLE TO EMPLOYEES. OBSERVED NO HEIMLICH MANEUVER SIGN POSTED. * denotes critical violation Exhibit A Case Number: 2004035798 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number. 7406129 Received Event (Event Succeeded) Date: 2/22/2005 Time: 11:46 AM Pages: 6 Duration: 2 min 20 sec Sender: 8504146749 Company: Fev Number: Subiant @2/22/2805 11:44 8584146749 DBPR OGA PAGE 85/86 T * 6.45-30 4A-21.804FAC INSTALLATION; SERVICE. (1) ALL PRE-ENGINEERED SYSTEMS ARE TO BE INSPECTED IN ACCORDANCE WITH THE STANDARDS ADOPTED IN 4A-21-302, F.A.C, (2) WHENEVER A PRE-ENGINEERED SYSTEM [S INSTALLED, INSPECTED, REPAIRED, MAINTAINED OR OTHERWISE SERVICED, THE PERMITTEE SHALL COMPLETE AN INSPECTION REPORT CONTAINING, AT AMINIMUM, THE INFORMATION IN PARAGRAPHS (A) THROUGH (0), IN THIS SUBSECTION. ONE COPY SHALL BE SIGNED BY AND DELIVERED TO THE OWNER, OR THE REPRESENTATIVE OF THE OWNER, OF THE FACILITY IN WHICH THE SYSTEM WAS INSTALLED. THE OTHER COPY SHALL BE RETAINED IN THE FIRE EQUIPMENT DEALER'S FILES. (A) LOCATION OF SYSTEM; SUSINESS NAME OF FACILITY, STREET ADDRESS, CITY , STATE, ZIP CODE, PHONE NUMBER, AND NAME OF THE OWNER OR MANAGER; (B) WHETHER THE REPORT IS FOR AN ANNUAL INSPECTION, SEMI-ANNUAL INSPECTION; A RECHARGE; A NEW INSTALLATION; OR A RENOVATION; (C) WHERE THE SYSTEM IS LOCATED IN THE FACILITY; (D) TYPE OF SYSTEM; NAME OF MANUFACTURER; MODEL NUMBER, SIZE OF BOTTLES; (E) METHOD AND DEGREE OF ACTUATION; (F) REFERENCE TO DRAWING NUMBER AND PAGE NUMBER IN THE MANUFACTURER'S MANUAL, (G) DATE OF LAST HYDROSTATIC TEST; (H) DATE OF LAST RECHARGE; (1) SERIAL NUMBER; (J) WHETHER FUEL SHUT OFF IS GAS OR ELECTRIC AND THE SIZE; (K) A DRAWING OF A NEW INSTALLATION; A FIRST INSPECTION; OR WHENEVER CHANGES ARE MADE (THE DRAWING SHALL INCLUDE THE SIZE OF THE HOOD AND THE SIZE OF THE DUCTS); AND THE SIZE, AND TYPE OF ALL APPLIANCES PROTECTED; (L) RESPONSES TO THE FOLLOWING QUESTIONS: 1. WERE THE INSPECTION AND MAINTENANCE PERFORMED IN ACCORDANCE WITH THE PRESENTLY ADOPTED EDITIONS OF NFPA [INDICATE STANDARD(S)] USED - ("NO" ANSWERS REQUIRE AN EXPLANATION), 2. WAS THE SYSTEM TAGGED IN ACCORDANCE WITH RULE 4A-21.303, F.A.C.? ("NO ANSWERS REQUIRE AN EXPLANATION) 3. WERE THE INSPECTION AND MAINTENANCE PERFORMED IN ACCORDANCE WITH THE MANUFACTURER'S MANUAL AND THE MANUFACTURER'S SPECIFICATIONS? ("NO" ANSWERS REQUIRE AN EXPLANATION), (M) A COMMENTS SECTION TO ALLOW FOR EXPLANATIONS IF NECESSARY, (N) A STATEMENT THAT THE PERMITTEE CERTIFIES THAT HE PERSONALLY INSPECTED THE SYSTEM AND FOUND THE CONDITIONS TO BE AS INDICATED ON THE REPORT; (0) THE PERMITTEE'S NAME, SIGNATURE AND PERMIT NUMBER; THE DATE; AND THE CUSTOMER'S SIGNATURE, THERE WAS NO INSPECTION REPORT FROM A LICENSED EQUIPMENT DEALER. 7, 58-01 509.101(2) FS EACH OPERATOR SHALL MAINTAIN AT ALL TIMES A CURRENT COPY OF THIS CHAPTER IN THE OFFICE OF THE LICENSED ESTABLISHMENT WHICH SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. A COPY OF THE GHAPTER 509, FLORIDA STATUTES, WAS NOT AVAILABLE IN THE ESTABLISHMENT. * denotes critical violation Exhibit A Case Number. 2004035796 Page 2 License Type: 2010 PERMANENT FOOD SERVICE License Number: 7406129

Docket for Case No: 05-000595