You get your art printed, then use it as a template to cut your board. Don't actually leave it on the board while cutting, but lay it over the board, make a mark on the board through the centerpoints in the button / joystick holes that you designed, then cut. Don't actually make big black circles on your CPO art for the holes.. just use tiny white dots for position. Once the holes have been cut on the board, you can apply the art and then cut the holes out.