Jul 26 2006 13:44 a7/ 26/2886 13:48 8584146749 DEPR OGA PAGE 3/11 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs, License No, 2313582 COFFE SHOP oe seeeRA License Type 2010 Permanent Food Service Ssponcent. Case No. 2005024842 / . ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Administrative Complaint against COFFE SHOP SANTA BARBARA, (“Respondent”), and says: 1. Petitioner is the state agency charged with regulating the operation of public ladging establishments and public food service establishments, 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 1731 SW 8 ST, MIAMI, FLORIDA 33136.The mailing address of record is COFFE SHOP SANTA BARBARA, at 1731 SW 8ST, MIAMI, FLORIDA 33135. 3. Inspection of this establishment conducted pursuant to See, 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. Inspection documents are attached as Exhibit "B", 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 Departprent's Hospitality Education Program: suspension, revocation, or refusal of 4 license issued purSuényto this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, of the rules dro fi ., Signed May 04, a) Director, or designee Division of Hotels & Restaurants Department of Business & Professiona! Regulation COUNSEL FOR THE DEFARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No. 0153831 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7160 3901 9848 8548 7501 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2005. Received by: Inspector's Signature Operator's Signature Title Title Case Number; 2005024842 Fos ravised 04.10.05 License Type: 2010 Permanent Food Service Distriet Number: 01 COFFE SHOP SANTA BARBARA License Number: 2313582 Jul 26 2006 13:44 a7/ 26/2886 13:48 8584146749 DEPR OGA PAGE @4/11 License Number: 2313582 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2005024842 Exhibit A “FC" as cited herein references specific provisions of the Foad Code, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Code, "NFPA" as cited herein references specific provisions of the National Fire Protection Association Life Safety Cade, incorporated by reference at Chapter 4A-3, "Fire Prevention, General Provisions’, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code, It is alleged that on February 18, 2005, and April 112005, the licensee was in violation of Florida Statute 909(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Cade (FAC), in the following particulars. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. 1, 32-02 8-301.14 FC AND 61C-1.004(2)(C) FAC + HANDWASHING SIGNAGE. A SIGN OR POSTER THAT NOTIFIED FOOD EMPLOYEES TO WASH THEIR HANDS SHALL BE POSTED AT ALL HANDWASHING LAVATORIES USED BY FOOD EMPLOYEES AND SHALL BE CLEARLY VISIBLE TO FOOD EMPLOYEES, OBSERVED LACK OF HANDWASHING SIGN AT A HANDSINK USED BY FOOD EMPLOYEES. 2, 32-09 6-301.12FC HAND DRYING PROVISION, EACH HANDWASHING LAVATORY OR GROUP OF ADJACENT LAVATORIES SHALL BE PROVIDED WITH: (A) INDIVIDUAL, DISPOSABLE TOWELS; (B) A CONTINUOUS TOWEL SYSTEM THAT SUPPLIES THE USER WITH A CLEAN TOWEL; OR (C) A HEATED-AIR HAND DRYING DEVICE, OBSERVED LACK OF PROPER HAND DRYING PROVISIONS AT HAND SINK. 3. 36-03 6-501.12 FC CLEANING, FREQUENCY AND RESTRICTIONS. (A) THE PHYSICAL FACILITIES SHALL BE CLEANED AS OFTEN AS NECESSARY TO KEEP THEM CLEAN. (B} CLEANING SHALL BE DONE DURING PERIODS WHEN THE LEAST AMOUNT OF FOOD IS EXPOSED SUCH AS AFTER CLOSING, THIS REQUIREMENT DOES NOT APPLY TO CLEANING THAT IS NECESSARY DUE TO A SPILL OR OTHER ACCIDENT. OBSERVED GREASE ACCUMULATED UNDER COOKING EQUIPMENT.. 4.37-02 61C-1.004(6) FAG ALL BUILDING STRUCTURAL COMPONENTS, ATTACHMENTS AND FIXTURES SHALL BE KEPT IN GOOD REPAIR, CLEAN AND FREE OF OBSTRUCTIONS. OBSERVED HOLES IN WALL THROUGHOUT THE KITCHEN, " §.48-01 610-1,004(13)(A) FAC GAS APPLIANCES -- ALL APPLIANCES, INCLUDING WATER HEATERS USING GAS, SHALL BE KEPT IN GOOD REPAIR AND PROPERLY VENTED WHEN MANUFACTURERS' INSTRUCTIONS REQUIRE VENTING OF THE APPLIANCE AND SHALL MEET THE FOLLOWING REQUIREMENTS: (A) ALL APPLIANCES SHALL HAVE A NATIONALLY RECOGNIZED TESTING LABORATORY SEAL SUCH AS AGA OR UL SEAL. OBSERVED FRYER EXTENDED PAST END OF HOOD, * denotes critical violation Exhibit A Case Number: 2005024842 Page 4 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2313582 a7/ 26/2886 13:48 8584146749 DEPR OGA CALLBACK INSPECTION REPORT LEGAL NOTICE Jul 26 2006 13:44 PAGE 5/11 Page i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS wine, myflorida.com/dbpr d LIGIHXa Fallure to comply with this Natiee may initiate an administrative complaint that may result in suspension or revocation of Your licen 4/14/05 12:50:00 PM Warning and fines. SEA2313582 SEAT Callback Inspection Date and Tire Inspection Reason License Number COFFE SHOP SANTA BARBARA CORP Owner Name COFFE SHOP SANTA BARBARA | jAPMINISTRATIVE COMPLAINT recommended, ! | Ares Code/Telephons Number __t Business Nate Inspection Result 02/18/2008 20 Number of Units ~ Requested Caliback Gate/Time Initial Warning Date 1741 SW 8 ST MIAMI FL 33135 Address 7 City 7 Bist J zip / ete. Comments pe i The following item(s) have bean recommended for Administrativa Complaint: iplation: 32-02 ‘Observed lack of handwashing sign at a handgink ued by food employees. I Milation; 32-09 Observed lack of proper hand drylng provisions at hand wash sink. Violation: 36-03 Tate Signature of Recipient Recipiant: Barbara Gonzalez Title Person incharge Phone; 305-649-5540 MEPE Form be 5022-005 Inspector Signature For further Information please contact: Guillarmo Alonso 850-487-1295 Jul 26 2006 13:45 7/26/2686 13:48 8584146749 ; DEPR OGA HIBI r B PAGE 6/11 Page 2 STATE OF FLORIDA License Nuraber DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEAT SEAD3135; DIVISION OF HOTELS AND RESTAURANTS ' www. myflorida.com/dbpr Business Name COFFE SHOP SANTA BARBARA Inspection Date 4fil/05 12:50:00 PI Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your licens and fines. CALLBACK INSPECTION REPORT LEGAL NOTICE Observed grease accumulated under coaking equipment. Violation: 37-02 Observed holes in wall thru aut kitehen . Vielation; 48-01, Observed fryer extended past end of hood 1 [The following item(s) have been submitted for a Time Extension: t Miolation: 45-30 | Dbserved lack of inspection report from licensed equipment dealer on premise. te following item(s) ere in compliance: iolatlon; 034-03 ‘Observed potentially hazardous food cold held at greater than 41 F, lelatlart: 31-12 Observed handwash sink used for purposes other than handwashing. Miolation: 32-14 Observed lack of handwashing cleanser at handwashing lavatory. Violation: 45-10 Observed portable extinguisher with tag out-of-date. iolation: 538-04 Observed no proof of required employee training, This vielation must be corrected by ; 2/21/05. SWIM Form MR 5022-005 a7! 26/ 2086 Jul 26 2006 13:45 DEPR OGA ar/l1 PAGE EXHIBIT B Page i 8584146749 13:46 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS www. nyflorida.com /dbpr FOOD SERVICE INSPECTION REPORT , LEGAL NOTICE Failure to comply with this Notice may Initiate an administrative complaint that may result in suspension or revocation of four licer and finas, 2313582 SEAT License Number 2/28/08 2:02:09 PM Routine Inspection Date gnd Time Inspection Reason COFFE SHOP SANTA BARBARA CORP See WARNING: Owner Name | COFFE SHOP SANTA BARBARA Violations In the operation of your [establishment must be corrected by: Area Code/Telephane Number Business Narne 20 Number of Units 1721 SW 8 ST snspectian Result ~ “(95/21/2005 08:00 Al “Callback Date/Time 10/105 Uicettse Expiration MIAMI FL 33135 Address / City state 7 zip f etc. tem 03: Food Temperatures i Ttem 538; Cert. Food Managers Ttem 20: Warewashing Sanitizatlon Ttern 45; Fire Extinguishers and Firt Suppression Systams Dates a - . | Rice, hot helding, 188 Degrees F. [ Pork, hot hetding, 142 Degrees F , Chicken, reach in eooler, 15 Dagraps F. ‘Beef, raw, reach in cooler, 4B Degrees F. 7 Ham, retch in cooler, 42 Dagrass F, Manager Name: Surely Molina San Certification Oate: 6/28/04 Certified by: National Registry of Food Safety Professionals | A Class ABC type Fire Extinguisher, found in/ Sininy room has 8 certification date of 1/04 A Hood Suppression type Ara Extinguisher, found In/at kitchen has a certification date of 10/04 A.Class GC type Fire Extinguisher, found In/at kitchen has a certification date af 10/04 titer Type: Not Set Up —-. a —. NOTE: Items marked above with an asterisk (*) indicate a violation Inspector's Comments | H H | L Tecknewledge teceipt of this Inspection form and comments. bo tee i, AfAB/O5 bate “Signature of Recipient Inspector Signature For further information plaase contact: Recipient: Marta Carrera . Guillermo Alonso Title Person incharge 280-487-1995 Phone: 305-649-5540 “STATUS | SOURCE ] (TORECONTROL i — Yes "Ola Approved source Yes [7035 Hot food at proper temperature Yes *016 Wholesome, sound condition ras |“03c Foods properly cocked/reheated P | : — — “Yes ; 02 Original container; properly labeled, date marking "Yes 03d Foods properly coaled _ STATUS PHE TEMPERATURE CONTROL Yes *04 Facliities to raintaln product temperature No ~ =(3a Cold food at proper temperatures during storage, display, : Yes 705 Thermometers provided and conspicuously placed service, transpert, and cold holding Yee *06 Potentially hazardous foods properly thawed “marked with an asteriak are eritigal violations, Items marked VES are tn compliance, Itemie jes Marked NO are viclatons. Specific detaits af violation are listed on subsequent pi ‘lem marked N/A are Mot Apoitcable. Trams Marked as N/ bre Not Ohseived, and were nat belng conducted at the time of Inspection. NGER For HP A285 Jul 26 a7/ 26/2886 13:48 8584146749 DEPR OGA STATE OF FLORIDA 2006 13:45 PAGE 8/11 EXHIBITB , DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Nurpnber DIVISION OF HOTELS AND RESTAURANTS SEAT 2313582 www. myfiorida.com/dbpr Inspection Date FOOD SERVICE INSPECTION REFORT 2/18/05 2:02:05 LEGAL NOTICE sh 209 PM Fallure to comply with this Notice may Initiate an administrative complaint that may result in suspension or revocation of Your leer ~ STATUS — PHF TEMPERATURE CONTROL “f STATUS | GARBAGE AND REFUSE DISPOSAL Yes =07 Unwrapped or potentially hazardous food hot re-eerved Yas 133 Containers covered, adequate number, insect anc rorent ‘es 08a Food protection during storage, preparation, display, ‘ (Proof, emptied at proper intervals, clean iservicg, transpartation jves 34 Outside storage area clean, enclosure properly constructs Yes 7" *06b Cross-contammation, equipment, personnel, storage i | Ver 9g Potential far cross-contamination; storage practices; STATUS INSECT AND RODENT CONTROL - idamaged Food segregated Yeu "}¥35a Presence of insects/radents, Animals prohibited #99 Foods handled with minimum contact Yes 35b Outer openings protected from insects, rodent proof 10 Tn use food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS PERSONNEL No 86 Floors properly constructed, clean, drained, coved #11 Personnel with infectlons restricted (No ny) Walls, ceilings, and attached equipment, constructad, clea “12a Hands Washed and dlaan, gaod hyglenie practices (observed), alternative operating pian Yes “5 Lighting provided as required. Fidures shielded Ves — [*12b Proper hyglanic practices, eating/drinkIng/amaking Yea 89 Reoms and equipment - vented a8 required i (evidence) STATUS OTHER ARFAS tyes (33 Clean dathes, halr restraints Yee 40 Employee lockers provided and used, clean rr STATUS | “FOOD EQUIPMENT AND UTENSILS Fes *4iq Toxic terns properly etered : Yes ™ }44 Food cantact surfaces designed, constructed, malntained, Yes +4ib Toxle tems labeled and used properly installed, Incatedl Yes _ ee Premises maintained, free of litter, unnecessary articles, | Ves XE Now-food coract surfaces designed, constructed, maintained, reat te anh ee erent property stored. Kitchen Yes “16 Dishwashing facilities designed, constructed, Dperated 1. Yes 43 Complete separation fram lIving/sleeping area, laundry Wash 2, Ringe 3, Sanitiza Yas 44 Claan end solled linen segregated and properly stored Ves «LaF Thermomaters, gauges, test kits provided “STATUS | SAFETY i Yes | 28 Pre-Alushed, scraped, soaked No 45 Fire extinguishers - proper and sufficient | Yes |19 Wash, Hinge water claan, proper temparature Yes 46 Exiting aystem - adequate, good repair "ves "Tab Sanitizing concentration Yes "ha? Electrical wiring - adequate, good repair Yes —~ j*20b Sanitizing temperature No 48 Gas appliances = properly Installed, maintained Yes 21 Wiping cloths clean, used properly, stored Yes 4 Flammable/cambustible materials = properly stored i [22 Food contact surfaces of equipment and utensils dean STATUS GENERAL “a3 Non-food contact surfaces clean Yes 50 Current license properly displayed ! "a Storagerhandiing of claan equipment, utensils Yes 81 Other conditions sanitary and safe operation - SINGLE SERVICE ARTICLES Yes” 1 53 Fatinstenaina statements published or advertised retatin: 25 Service items properly stored, handled, dlapensed ta foad/beverage 126 Single Service articles not re-used Yes S38 Food management certification valid ' WATER AND SEWAGE/PLUMBING Ne #536 Employes: training validation 6 a Water source safe, hot and cold under pressure Yes 34 Florida Clean Indoor Alr Act Veg #38 Sewage and waite water dleposed properly Yes IBS Autornatic Gratuity Notice Yes 129 Plumbing installed and maintained ~ Nes 56 Copy of Chapter 509, Florida Statutes, avallable Ye :*30 Crose-connection, back siphonage, backflow “STATUS GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 7 Hospitality Education Program Information provided Wo OT Toller and handwashing facilities, number, convenient, | Yes iB Smake Freé ” " ~ designed, installed No" "35 Restrooms with self-closing dears, fixtures operate properly, | facility clean, supplied with handsoap, dispesable tewels or hand ' drying devices, tissue, covered waste receptacles : ' Total Number of COS Vislations: a ' Total Number of Repeat Violations: it) ie. with an asterisk aré critical vialations. Items marked YES are In compliance. tteme Marked HO Aare Nut Applicable, Items Marked as N/O are Not Obsorved, and were hot belng conducted at WAQG hecem. oD GITLATR are violations. Spacifie detalls of violation are listed on subsequent pages. the time of Inspection Jul 26 2006 13:45 7/26/2686 13:48 8584146749 DEPR OGA _ Hip . PAGE 89/11 STATE OF FLORIDA Page 5 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Number DIVISION OF HOTELS AND RESTAURANTS SEAT 2313582 www, myflorida.cem/dbpr Inspectian Date FOOD SERVICE INSPECTION REPORT 53: LEGAL NOTICE 2/18/05 2:02:09 pM Failure te comply with this Notes may initiate an administrative complaint that may rasult in suapension or revocation of your Heen: and fines, Warnlng(s}: S28-D1 + Observed no proof of required employee training. This vialation must be corrected by : 3/21/05, REFERENCE TEXT: 509.049 FS : Food service employee training. The division shall adopt, by rule, minimum food safety pratection standards for the training of food service employees who are responsible for the starage, preparation, display, or serving of foods to the public In establishments regulated under this chapter These standards shall not Include an examination, but shall provide for a food safety tralning certificate program far food service employees to be adrninistered b a private nonprofit provider chosen by the division. Any food safety training program established and administered to food handler employees prlor to the effect date of this act shall be submitted by the operator te the division for itz review and approval. It shall be the duty of the licensee of the publle food service establishment te provide training In accordance with the described rule to all employees under the ficenses's supervision or control. The lcanses may designate certified food service manager to perform this function as an agent of the licensee. Food service employees must receive certification pursuant to this section by January 1, 2001. Poad service employees hired after November 1, 2000, must recelva certification within 60 days after employment, Cartificatton pursuant ta thi section shall remain valid for 3 years, Vietatlan{s): O2A-03 - Observed potentially hazardous food cold held at greater than 41 F. REFERENCE TEXT: 3-801.16(B) FC ; Except during preparation, cooking, or cooling, or when Hime is used as the publle health control as specified under 3-501.19, POTENTIALLY HAZARDOUS RIOD shall ba maintained: (B) ...(41 degrees F) or lese, excapt as specified under (C) of this eaction and 3-501.17, 3-804.18, and 4 ab4421, . 31-12 - Ghserved handwash sink used for purposes other than hatdwashing, REFERENCE TEXT: §-205.11(8) FC : A handwashing lavatory may nok be ysed for purposes other than handweshing. 32-02 - Observed lack of handwashing sign at a handsink used by food employees. REPERENCE TEXT: 6301.14 PC and G1C-1.004(2)(c) FAC : Handwashing Slanage. 4 sign or poster that notified FOOD EMPLOYEES to wesh thelr hands shall be posted at all handwashing lavatories used by FOOD EMPLOYEES and shall be clearly visible to FOOD EMPLOYEES, 34-14 - Observed lack of handwashing cleansor at handwashing favatary, REFERENCE TEXT: 6-302.11 FC : Handwashing Cleanser, Availability. Each handwashing lavatory or group of 2 aciacent lavatories shall be provided with a supply of hang cleaning fiquid, powder, or bar soap. 32-08 - Observed lack of proper hand drying provisions at hand wash sink, REFERENCE TEXT: 6301.12 FO : Hand Drying Provision. Each handwashing lavatory or group of adjacent lavatories shall be provided with: {A} Individual, disposable towels; (B} A continuous towel system that supplies the user with a clean tawal: or (C) A heated-air hand drying deviee. 36-03 - Observed grease accumulated under cooking equipment, 37-02 - Qhserved holes In wall thru out kitchen . REFERENCE TEXT: 61C-1.004(6) FAC : All bullding structural components, attachments and fixtures shall be keot In good repair, clean and free af obstructions, 45-10 - Gbsetved portable extinguisher with tag out-ofedate, REFERENCE TEXT: NFPA 10, 4-4.1 : Extinguishers shell be subjected ta maintenance, nat more than one year apart, 45-20 - Observed lack of inspection report from lleensed equipment dealer on premise, REFERENCE TEXT; 44-21,304 FAC ; Installation; Service, (2) All pre-engineered systerns are to be Inspected in accordance with the standards Adopted In 4As21« 202, FAC, (2) Whenever 8 pre-engineered system is Installed, Inspected, repaired, maintained or otherwise serviced, the permittee shall complete an inspection Teport containing, at 2 minitrum, the information In paragraphs (a) through (4), in this subsection, One capy’shall be signed by and delivered ts the owner, or the representative af 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 2M); business name of facility, street address, city , stata, 20 code, phone number, and name of the owner or manader: (b) Whether the report Is for an anaual cactlon, semi-annual inspection; 3 recharge; 3 new installation; or a rénovation; (c) Where the syatam Is tocated jn the facility; (d) Type of system; name of hufacturer; model number; size of bottles; (#) Method and degree of actuation; (F) Reference to drawing number and page number tn the manufscturar's manual; (g) Date of last hydrestatic test; (h) Date of last recharge; (i) Serial number; (j) Whether fuel shut off s gas or electric and the size: (k) A drawing of a rex instalation; a first inspectian; or whenever changes are made (the drawing shall include the size of the hood ang the size of the ducts); and the size, and type Boplinnces protected; (1) Responses to the following questions: 1, Were the insoection and maintenance performed In accardance with the presently adopted vig af NRA [indicate standard(s)] used » ("No" answers ORPR Far HR 5022-015 a7/ 26/2886 13:48 8584146749 Jul 26 2006 13:45 DEPR OGA PAGE 18/11 Page 4 STATE OF FLORIDA 3 DEPARTMENT OF BLISINESS AND PROFESSIONAL REGULATION License Number DIVISION GF HOTELS AND RESTAURANTS SEAT 2313585 www. myflorida.com/dbpr Inspection Date FOOD SERVICE INSPECTION REPORT 2/18/05 2:02: LEGAL NOTICE eins 2 2 PM Failure to comply with this Notkea may inktinte an administrative complaint that may resuit in suspension of revocation of ¥our licen: and fines, require en explanation); 2. Was the systern tagged in accordance with Rule 4A-21.303, FA.C.? ("No" answers require an exilanation) 2. Were the inspection and maintenance performed in accardance with the manufacturer's manual and the manufacturer's specifications? ("No” answers requita 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 repert; {0} The permittee’s rare, signature and permit number; the date: and the customer's Signature. 48-01 - Observed fryer extended past end of hood PAE corn HA MALLS

Docket for Case No: 06-002700