<x-admin.layout>
    <x-slot name="title">Certificate of good condition of air, access roads, and buildings/खेळती हवा, पोहोच रस्ते, व इमारती सुस्थितीत प्रमाणपत्र</x-slot>
    <x-slot name="heading">Certificate of good condition of air, access roads, and buildings/खेळती हवा, पोहोच रस्ते, व इमारती सुस्थितीत प्रमाणपत्र</x-slot>

<div class="row" id="addContainer">
    <div class="col-sm-12">
        <div class="card">
            <form class="theme-form" name="addForm" id="addForm" enctype="multipart/form-data">
                @csrf

                <div class="card-header">
                    <h4 class="card-title">Add Details / माहिती भरा</h4>
                </div>

                <div class="card-body">

                    {{-- Applicant Details --}}
                    <h5 class="text-primary">Applicant Details / अर्जदाराची माहिती</h5>
                    <div class="mb-3 row">

                        <div class="col-md-4">
                            <label class="col-form-label" for="applicant_name">Applicant Name / अर्जदाराचे नाव<span class="text-danger">*</span></label>
                            <input class="form-control" id="applicant_name" name="applicant_name" type="text" placeholder="Enter Applicant Name / अर्जदाराचे नाव भरा" required>
                            <span class="text-danger is-invalid applicant_name_err"></span>
                        </div>

                        <div class="col-md-4">
                            <label class="col-form-label" for="applicant_address">Applicant Address / अर्जदाराचा पत्ता<span class="text-danger">*</span></label>
                            <input class="form-control" id="applicant_address" name="applicant_address" type="text" placeholder="Enter Address / पत्ता भरा" required>
                            <span class="text-danger is-invalid applicant_address_err"></span>
                        </div>

                        <div class="col-md-4">
                            <label class="col-form-label" for="mobile_no">Mobile Number / मोबाईल नंबर<span class="text-danger">*</span></label>
                            <input class="form-control" id="mobile_no" name="mobile_no" type="text" placeholder="Enter Mobile No. / मोबाईल नंबर भरा" maxlength="10" pattern="\d{10}" title="Please enter exactly 10 digits" required inputmode="numeric" oninput="this.value = this.value.replace(/[^0-9]/g, '').slice(0,10);"  required>
                            <span class="text-danger is-invalid mobile_no_err"></span>
                        </div>

                        <div class="col-md-4">
                            <label class="col-form-label" for="email_id">Email ID / ईमेल आयडी<span class="text-danger">*</span></label>
                            <input class="form-control" id="email_id" name="email_id" type="email" placeholder="Enter Email ID / ईमेल भरा" required>
                            <span class="text-danger is-invalid email_id_err"></span>
                        </div>
                    </div>

                    {{-- Owner Details --}}
                    <h5 class="text-primary">Owner Details / मालकाची माहिती</h5>
                    <div class="mb-3 row">
                        <div class="col-md-4">
                            <label class="col-form-label" for="owner_name">Name of School / Institute / शाळा / संस्था नाव<span class="text-danger">*</span></label>
                            <input class="form-control" id="owner_name" name="owner_name" type="text" placeholder="Enter School/Institute Name / शाळा/संस्थेचे नाव" required>
                            <span class="text-danger is-invalid owner_name_err"></span>
                        </div>

                        <div class="col-md-4">
                            <label class="col-form-label" for="owner_address">School/Institute Address / शाळा/संस्थेचा पत्ता<span class="text-danger">*</span></label>
                            <input class="form-control" id="owner_address" name="owner_address" type="text" placeholder="Enter Address / पत्ता भरा" required>
                            <span class="text-danger is-invalid owner_address_err"></span>
                        </div>

                        <div class="col-md-4">
                            <label class="col-form-label" for="prabhag_samiti">Prabhag Samiti / प्रभाग समिती<span class="text-danger">*</span></label>
                            <input class="form-control" id="prabhag_samiti" name="prabhag_samiti" type="text" placeholder="Enter Prabhag Samiti / प्रभाग समिती भरा" required>
                            <span class="text-danger is-invalid prabhag_samiti_err"></span>
                        </div>
                    </div>

                    {{-- Documents --}}
                    <h5 class="text-primary">Documents / कागदपत्रे</h5>
                    <div class="mb-3 row">
                        <div class="col-md-3">
                            <label class="col-form-label" for="cc_oc_certificate">CC and OC Certificate / CC आणि OC प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="cc_oc_certificate" name="cc_oc_certificate" type="file" required>
                            <span class="text-danger is-invalid cc_oc_certificate_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="fire_noc">Fire NOC / अग्निशमन प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="fire_noc" name="fire_noc" type="file" required>
                            <span class="text-danger is-invalid fire_noc_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="solid_waste_noc">Solid Waste Department NOC / ठोस कचरा विभागाचे प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="solid_waste_noc" name="solid_waste_noc" type="file" required>
                            <span class="text-danger is-invalid solid_waste_noc_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="structural_stability_certificate">Structural Stability Certificate / संरचनात्मक स्थिरता प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="structural_stability_certificate" name="structural_stability_certificate" type="file" required>
                            <span class="text-danger is-invalid structural_stability_certificate_err"></span>
                        </div>
                    </div>

                    <div class="mb-3 row">
                        <div class="col-md-3">
                            <label class="col-form-label" for="electrical_safety_certificate">Electrical Safety Certificate / विद्युत सुरक्षा प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="electrical_safety_certificate" name="electrical_safety_certificate" type="file" required>
                            <span class="text-danger is-invalid electrical_safety_certificate_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="water_supply_sewage_noc">Water Supply and Sewage NOC / पाणी पुरवठा आणि मलनिस्सारण प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="water_supply_sewage_noc" name="water_supply_sewage_noc" type="file" required>
                            <span class="text-danger is-invalid water_supply_sewage_noc_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="prabhag_office_noc">Prabhag Office NOC / प्रभाग कार्यालय प्रमाणपत्र<span class="text-danger">*</span></label>
                            <input class="form-control" id="prabhag_office_noc" name="prabhag_office_noc" type="file" required>
                            <span class="text-danger is-invalid prabhag_office_noc_err"></span>
                        </div>

                        <div class="col-md-3">
                            <label class="col-form-label" for="school_gps_photo">School GPS Photo / शाळेचे GPS फोटो<span class="text-danger">*</span></label>
                            <input class="form-control" id="school_gps_photo" name="school_gps_photo" type="file" required>
                            <span class="text-danger is-invalid school_gps_photo_err"></span>
                        </div>

                          <div id="upload_section" style="display: none;">
                                <div class="col-md-4 mb-2">
                                    <label class="col-form-label" for="upload_prescribed_format">Upload Application in Prescribed Format / विहित नमुन्यातील अर्ज अपलोड करा <span class="text-danger">*</span></label>
                                    <input class="form-control" id="upload_prescribed_format" name="upload_prescribed_format" type="file" required>
                                    <span class="text-danger is-invalid upload_prescribed_format_err"></span>
                                </div>
                            </div>
                    </div>

                    {{-- Declaration --}}
                    <div class="mb-3 row">
                        <label class="col-form-label" for="is_correct_info">Declaration / घोषणापत्र:</label>
                        <div class="col-md-12">
                            <div class="form-check d-flex align-items-start">
                                <input type="checkbox" class="form-check-input mt-1" id="is_correct_info" name="is_correct_info" value="yes" required>
                                <label class="form-check-label ms-2" for="is_correct_info">
                                    "All information provided above is correct and I shall be fully responsible for any discrepancy."
                                    वरील पुरविलेली सर्व माहिती अचूक आहे व त्यामध्ये कोणतीही चूक आढळल्यास मी पूर्णपणे जबाबदार असेन."
                                </label>
                            </div>
                            <span class="text-danger is-invalid is_correct_info_err"></span>
                        </div>
                    </div>

                </div>

                {{-- Footer --}}
                <div class="form-group" style="text-align: center;">
                    <button type="button" id="saveAndPrintBtn" class="btn btn-success">Save and Print</button>
                </div>
                <div class="card-footer" id="card-footer" style="display: none;" >
                    <button type="submit" class="btn btn-primary" id="addSubmit">Submit / सादर करा</button>
                    <button type="reset" class="btn btn-warning">Reset / पुन्हा भरा</button>
                </div>

            </form>
        </div>
    </div>
</div>


</x-admin.layout>


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</script> --}}

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