The cake shop behind the jester gave me the idea for this image.

The cake and the tray are modified Photo Objects with added drop shadows. The reflection of the cake in the tray is a copied layer with opacity reduced. The tablecloth is a fill from One-Click Wow with a canvas texture added. The wall is a white layer with a sandstone texture and a color layer added.

The decoration was done with a small circular white brush with the spacing set fairly high -- I used my Wacom pen & tablet to draw the outlines of the jester's head and lines to define the facial features. I added a low opacity drop shadow to make the 'wafers' look more like they were sitting on top of the icing.

All in all, ten layers. Everything was reshaped with the transform>perspective tool to make it fit together.