No certificate may be issued unless a completed application 

form has been received (14 C F ... R 91 101 and 105) 

0 From Approved: O.M.B. No.21 20-0027 08/31/2008 

US Department of Transportation APPLICANTS - DO NOT USE THESE SPACES 

Federal Aviation Administration Region 1Date 

APPLICATION FOR Action 

O Approved 0 Disapproved - "Explain under "Remarks" CERTIFICATE OF WAIVER Signature of authorized FAA representative 

OR AUTHORIZATION 

INSTRUCTIONS 

Submit this application in triplicate (3) to any FAA Flight fighting equipment. The applicant may also wish to submit Standards district office. photographs and scale d iagrams as supplemental material 

to assist in the FAA's evaluation of a particular site. Applicants requesting a Certificate of Waiver or Authoriza- Application for a Certificate of Waiver or Authorization must lion for an aviation event must complete all the applicable be s ubmitted 45 days prior to the requested date of the items on this form and attach a properly marked 7.5 series event. 

Topographic Quadrangle Map(s), published by the U.S. 

Geological Survey (scale 1:24,000), of the proposed opera!- Applicants requesting a Certificate of Waiver or Authorizaing area. The map(s) must include scale depictions of the lion for activities other than an aviation event will complete flightlines, showlines, race courses, and the location of the items 1 through 10 only and the certification , item 17, on the air event control point, Police dispatch, ambulance, and fire reverse. 

1. Name of organization 2. Name of responsible person 

DAVID L SLACK- AERIAL PHOTOGRAPHY DAVID L SLACK 

3. 

mailing 

Penmanent House number and street or route number City State and ZIP code Telephone No. 

17076 BIRDS EYE DR PERRIS CA 92570 9493946457 address 

4. State whether the applicant or any of its ptinetpal officers/owners has an application for waiver pending at any other office of the FAA. 

NO 

5. State whether the applicant or any of its principal officers owners has ever had its application for waiver denied, or whether the FAA has ever withdrawn a waiver from the applicant or any of its principal officers/owners. 

NO 

6. FAR section and number to be waived 

14 C.F.R. 91 .119 (B) AND (C) 

7. Detailed description of proposed operation (Attach supplement if needed) 

CLOSED-SET AERIAL FILMING & PHOTOGRAPHY FOR THE MOTION PICTURE FILM & TELEVISION INDUSTRIES. 

8. Area of operation (Location, altitudes, etc.) 

UNITED STATES OF AMERICA AND ITS TERRITORIES 

9a. Beginning (Date and hour) b. tna1ng (Date ana hour) 

06/01/2015 01:00:00 06/01/2017 01:00:00 

10. Aircraft Pilot's Name Certificate number Home address make a(~~ model and rating (Street, ~\~ . State) (b) (c) 

DJI PHANTOM 3 DAVID SLACK NA 17076 BIRDS EYE DR, PERRIS, CA 

DJI INSPIRE 1 DAVID SLACK NA 17076 BIRDS EYE DR, PERRIS, CA 

DJI 5900/1000 + A2 DAVID SlACK NA 17076 BIRDS EYE DR. PERRIS. CA 

FAA Form 7711 -2 (8-08) Supersedes Previous Edition 
.... ITEMS 11 THROUGH 16 TO BE FILLED OUT FOR AIR SHOW/AIR RACE WAIVER REQUE STS ONLY. 

11 . The air event will be sponsored by: 

12. Permanent House number and street or route number mailing 

City State and ZIP code Telephone No. 

address 

13. Policing (Describe provisions to be made for policing the event.) 

14. Emergency facilities (Marl< all that will be available at lime and place of air event.) 

D Physician 0 Fire truck 0 Other - Specify 

D Ambulance D Crash wagon 

15. Air Traffic control (Describe method of controlling traffic, including provision for arrival and departure of scheduled aircraft.) 

16. Schedule of Events (include arrival and departure of scheduled aircraft and other periods the airport maybe open.) 

Hour Date Event 

(a) (b) (c) 

If sufficient space is not available, the entire schedule of events may be submitted on separate sheets, in the order and manner indicated above. 

PleaseRe? 

The undersigned applicant accepts full responsibility for the strict observance of the terms of the Certificate 

of Waiver or Authorization, and understands that the authorization contained in such certificate will be strictly 

limited to the above described operation. 

17. Certification- 1 CERTIFY that the foregoing statements are true. 

Date 

05/16/2015 

Signatu ~~ 

Rema<Ks 

FAA Form 7711 -2 (8-08) Supersedes Previous Edition